CIHM 
Microfiche 
Series 
(Monographs) 


ICMH 

Collection  de 
microfiches 
(monographies) 


Canadian  Institute  for  Historical  Microroproductions  /  Institut  canadien  de  microreproductions  historiquos 


I 


Technical  and  Bibliographic  Notes  /  Notes  techniques  et  bibliographiques 


The  Institute  has  attempted  to  obtain  the  best  original 
copy  available  for  filming.  Features  of  this  copy  which 
may  be  bibliographically  unique,  which  may  alter  any  of 
the  images  in  the  reproduction,  or  which  may 
significantly  change  the  usual  method  of  filming  are 
checked  below. 


□ 


Coloured  covers  / 
Couverture  de  couleur 


j      I    Covers  damaged  / 


Couverlure  endommagee 


□    Covers  restored  and/or  laminated  / 
Couverlure  restauree  et/ou  pelliculee 

Cover  title  missing  /  Le  titre  de  couverlure  manque 

I I    Coloured  maps  /  Cartes  geographiques  en  couleur 

□    Coloured  ink  (i.e.  other  than  blue  or  black)  / 
Encre  de  couleur  (i.e.  autre  que  bleue  ou  noire) 

I      I    Coloured  plates  and/or  illustrations  / 


□ 


D 


Planches  et/ou  illustrations  en  couleur 

Bound  with  other  material  / 
Relie  avec  d'autres  documents 


□    Only  edition  available  / 
Seule  edition  disponible 

□  Tight  binding  may  cause  shadows  or  distortion  along 
interior  margin  /  La  reliure  serree  peut  causer  de 
I'ombre  ou  de  la  distorsion  le  long  de  la  marge 
interieure. 


Blank  leaves  added  during  restorations  may  appear 
within  the  text.  Whenever  possible,  these  have  been 
omitted  from  filming  /  II  se  peut  que  certames  pages 
blanches  ajoutees  lors  d'une  restauraton 
apparaisscnt  dans  le  texte,  mais,  lorsque  cela  e!ait 
possible,  ces  pages  n'ont  pas  ete  filmees 

Additional  comments  / 
Commentaires  supplementaires: 


L'Institut  a  microfilme  le  meilleur  exemplaire  qu'il  lui  a 
ete  possible  de  se  procurer.  Les  details  de  cet  exem- 
plaire qui  sont  peut-etre  uniques  du  point  de  vue  bibli- 
ographique,  qui  peuvent  modifier  une  image  reproduite, 
ou  qui  peuvent  exiger  une  modification  dans  la  metho- 
de  normale  de  filmage  sont  indiques  ci-dessous. 

Coloured  pages  /  Pages  de  couleur 

I I    Pages  damaged  /  Pages  endommagees 


□ 


□ 


n 


Pages  restored  and/or  laminated  / 
Pages  restaurees  et/ou  pelliculees 

Pages  discoloured,  stained  or  toxed  / 
Pages  decolorees,  tachetees  ou  piquees 

Pages  detachrd  /  Pages  detachees 


1    Showthrough /Transparence 

□    Quality  of  print  varies  / 
Qualite  inegale  de  I'impression 


Includes  supplementary  material  / 
Comprend  du  materiel  supolementaire 

Pages  wholly  or  partially  obscured  by  errata  slips, 
tissues,  etc.,  have  been  refilmed  to  ensure  the  best 
possible  image  /  Les  pages  totalement  ou 
partiellement  obscurcies  par  un  feuillet  d'errata,  uno 
pelure,  etc.,  ont  ete  filmees  a  nouveau  de  fatjion  a 
obtenir  la  meilleure  image  possible. 

Opoosmg  pages  with  varying  colouration  or 
discolourations  are  filmed  twice  to  ensure  the  best 
possible  image  /  Les  pages  s'opposant  ayant  des 
colorations  variables  ou  des  decolorations  sont 
filmees  deux  fois  afin  d'obtenir  la  meilleure  image 
possible. 


This  Item  is  filmed  at  the  reduction  ratio  checked  below  / 

Ce  document  est  lilme  au  taux  de  reduction  mdiauo  cidc&soLia 


lOx 

14x 

18x 

22x 

26x 

30x 

12x 


16x 


20x 


24x 


28x 


32x 


The  copy  filmed  here  has  been  reproduced  tha.ikj 
to  the  generosity  of: 

J.J.    Talman  Regional    Collection, 
D.B.    Weldon  Library, 
University  of  Western  Ont^ario 

The  images  appearing  here  are  ths  best  quality 
possible  considering  the  condition  and  legibiliry 
of  the  original  copy  and  in  keeping  with  the 
filming  contract  specificationa. 


L'exemplaire  fiim6  fut  reproduit  grace  d  la 
g^n^rosit^  de: 

J.J.    Taltnan  Regional    Collection, 
D.B.   Weldon   Library, 
University  of  Western  Ontario 

Les  images  suivantes  ont  ixi  reproduites  avec  le 
plus  grand  soin.  compte  tenu  de  la  condition  et 
de  la  nertetd  de  l'exemplaire  film6.  et  en 
conformity  avec  les  conditions  du  contrat  de 
filmaga. 


Original  copies  in  printed  paper  covers  are  filmed 
beginning  with  the  front  cover  and  ending  on 
the  last  page  with  a  printed  or  illustrated  impres- 
sion, or  the  back  cover  when  appropriate.  All 
other  original  copies  are  filmed  beginning  on  tl- « 
first  page  with  a  printed  or  illustrated  impres- 
sion, and  ending  on  the  last  page  with  a  printed 
or  illustrated  impression. 


Lea  exemplaires  originaux  dont  la  couverture  en 
papier  est  imprimAe  sont  filmis  en  commencant 
par  le  premier  plat  et  en  terminant  soit  par  la 
derniAre  page  qui  compone  une  empreinte 
d'impression  ou  d'illustration,  soit  par  le  second 
plat,  selon  le  cas.  Tous  les  autres  exemplaires 
originaux  sont  film^s  en  commenpani  par  la 
premiere  page  qui  comporte  une  empreinte 
d'impression  ou  d'illustration  et  en  terminant  par 
la  derni^re  page  qui  comporte  une  telle 
empreinte. 


The  last  recorded  frame  on  each  microfiche 
shall  contain  the  symbol       »   (meaning    "CON- 
TINUED"), or  the  symbol  V  (meaning    'END"). 
whichever  applies. 


Un  dee  symboles  suivants  apparaitra  sur  la 
derniAre  image  de  chaque  microfiche,  scion  le 
cas:  le  symbole  — ^  signifie    "A  SUIVRE",  le 
symbole  V  signifie   "FIN  ". 


Maps,  plates,  charts,  etc..  may  be  filmed  at 
different  reduction  ratios.  Those  too  large  to  be 
entirely  included  in  one  exposure  are  filmed 
beginning  in  the  upper  left  hard  corner,  left  to 
right  and  top  to  bottom,  as  many  frames  as 
required.  The  following  diagrams  illustrate  the 
method: 


Les  cartes,  planches    tableaux,  etc..  peuvent  etre 
filmis  d  des  taux  de  reduction  diff^rents. 
Lorsque  le  document  est  trop  grand  pour  etre 
reproduit  en  un  seul  cliche,  il  est  film^  i  par'ir 
de  Tangle  supArieur  gauche,  de  gauche  i  droite. 
et  de  haut  en  bas,  en  prenant  le  nombre 
d'images  n^cessaire.  Les  diagrammes  suivants 
illustrent  la  m^thode. 


1 

2 

3 

1 

2 

3 

4 

5 

6 

MICROCOPY    RESOIUTION    TEST    CHART 

^SSI  and  ISO  TEST  CHART  No    ? 


1.0 

m 

,2.2 

I.I 

1- 

2.0 
1.8 

1.25 

^■\ 

1.6 

^     /APPLIED  INA4GE     Inc 


A   Method   for  the   Determination  of 
Plasma  and   Blood  Volume 


X.     -M       K  111   il,     M  I) 

1-     <■..     \<  <  I  W   X  T  k  i;  j-.  Ml) 

AM) 

.1.    T    i;  I",  k  \  I.  II  T  >-,  M  h 


h\-rniil,;l    in. Ill    ih,-   .hrliitrs   ,<f   Inlcninl    Mcdicun' 
Oi-l,thi-r.  !'>l\  l',>!.  xi-i.  /-/>.  ^47-^71, 


AMtuirAN    Mkdicai    AssoriAT 

li^'     Hrv,,,, ,.    T  Minvl-ivi    Nmbtm    I),  vk 

I'llS 


'■'"'        .^TRtF.T 


I 


A    Ml-.TilOD    I'(_)R    TIIF.    DETERMIXATlUX 
AXb    BLijOD    volume* 


OF    PLASMA 


X.    M.    KEITH,    M  D.,    L.    G.    ROWXTREE,    M.D. 

AND 

J.    T.    GI-RAGHTV,    M.D. 

ISALTIMORi; 

Rrnuinc  red  cell  (.ount^  and  iR'innfjldliin  dcterniinations  yield  iiit'or- 
niation  that  is  valuable  but  \ery  incomplete.  This  information  con- 
cerns on.ly  the  concentration  of  the  blood.  The.-;e  routine  methods  do 
not  furnish  us  absolute  \alues  for  hemofjldbin,  for  red  cells,  or  for  the 
oxygen-carryinrj  cajiacity  of  the  blood.  With  them,  an  anemia  may 
be  more  aii]iarent  than  real,  as  it  may  be  dependent  on  or  associated 
w  ith  a  marked  increase  in  plasma  volume,  while  a  polycythemia  does 
not  necessarily  indicate  an  absolute  increase  in  reil  cells,  as  it  inay  be 
dependent  on  a  decrease  in  plasma.  In  order  to  obtain  absolute  values 
for  either  red  cells  or  hcmoi^dobin.  data  relative  to  plasma  volume  or 
total  blood  volume  are  essential. 

The  volume  as  well  as  the  concentration  of  the  blood  must  play  a 
role  in  ])atholos;ical  physiology.  Absolute  values  are  essential  to  the 
]>roper  intcri)retation  of  certain  pathological  findings.  Is  an  increase 
in  the  blood  mass  with  overfilling  of  tin-  vascular  system  m  any  way 
responsible  for  hypertension?  Is  the  large  heart  frequently  seen  in 
pernicious  anemia  due  to  a  large  blood  volume?  Is  the  large  heart 
sometimes  seen  in  myocardial  insufticicncy  (unassociated  with  hyper- 
tension or  nephritis)  due  to  an  increase  in  blood  mass?  Questions 
such  as  these  must  remain  unanswered  until  data  concerning  absolute 
\aiues  are  correlated  with  pathological  findings. 

\\  ith  so  great  variations  in  size  and  weight  of  in(lividuals,  the 
normal  xalucs  f^r  plasma  and  blood  are  best  expressed  in  percentages 
cir  fr.iclion-  i.f  the  body  \veit;ht.  or  a^  the  numi)er  of  cubic  centimeters 
])cr  kilogram  of  b(jdv  weight.  Since  the  work  of  W'elcker.  tiie  bloo.I 
has  been  considered  to  constitute  one-thirteenth  of  the  body  weight. 
Recently,  the  values  obtained  by  Ilaldane  and  Smitii  (one-twenty- 
lust),  and  by  Plesch  (one-nineteenth)  have  been  frequently  accepted. 
The  methods  affording  these  la>t  values  are  not  without  serious  draw- 
backs from  the  jioints  of  view  of  inherent  technical  error,  complicated 
nature  of  apparatus  re(iuired  and  the  possibility  of  injury  or  discom- 
fort atiendintr  their  use. 


*  From  the   Modiral   ;in(l  J.imes   riiuhaiMii   Br.iily  Urclogical   Clinics  of  tlie 
[lilin^  Hopkins   Ho-pitnl. 


TIrtc  i-  a  (li-liiul  uvlA  inr  a  >iiii|ilc  iihiIkhI  fcr  tlic  (k'lcniiinaliuii 
of  pla.-iiKi  and  MiukI  miUiiih',  |i,inicularly  lor  a  iiKilnMl  thai  can  lie 
rcpcatt'ilh'  a|ijilicil  witlmnt  iniur_\-  ti>  the  patient. 

I  111.  n;iM  iri.r  i<v   \  in:   mi.tiihh 

Ihi'  priiuiple  miMerlx  iii<4  thi-  mrthnd  i>  the  inlr(]<lmiiiin  direilly 
intn  the  eirciilatidii  nl'  a  nnn-tcxie.  -lowly  ali-nrhahle  dye,  whicii 
remains  in  the  ])la>nia  km,!,'  encju^h  for  ihorou.u'h  niixint;,  and  the  deter- 
mination of  its  concentration  in  tlie  pla-ma  colorinietrically  by  coni- 
pari-on  with  a  -iiitahle  >tamlard  mixture  of  dye  and  -enim. 

A  d\e  whicli  would  fiillil  the>e  conditions  wa-  r-ouj^ht.  Certain  of 
the  plilhaleins  were  tried  and  di-car<led  het-ause  of  the  rapidit_\-  with 
whicli  t!ie\-  lease  the  \a-cular  -y-tem.  i  >r.  lierl)ert  M.  I'van.-.  of  the 
Anatiiliiical  1  )epartnieiit.  when  coiiMilled  in  re;;ani  to  dye-  reinaiiiin.t,' 
for  a  loiii;  time  in  the  «.  irculation,  -iit^i^e-led  the  ]io--.ihilitie-  ol  vital 
red.  ami  -llp])lied  ii-  with  tiie  d\e  ii-etl  in  thi:^  work.  It  i-  with  yreat 
p!ea--ure  that  we  acknowledi;e  our  indebtedness  to  him. 

soMi-    I'Koi'ijM  ir.s  OF  Tin:  i)\i-: 

\  ilal  red  i-  di-odium  di-ulphoiiaphlhol  azolelramelhyl  tri[)hen}l 
melhane. 

C!In  V  .  CHa 


XaOSV/ 


so  X.i 


H 

] 

■C- 


CM,,    ^.^      n, 


>C  =  X 

i 


ID 


xao,.s\y\y -^L'N'a 


It  i-  water  -olulile  to  die  exlent  of  1  '  .■  per  cent,  in  dilute  solulioii> 
of  cud  jier  cent,,  it  doe-  not  dialw.e  at;ain-t  water  tliroii^h  collodion 
-ac-  e\eii  in  fort\  ei;^ht  hour-.  I'lider  -nch  condition-,  the  dye  i- 
practicallv  ad-orhed  h_\-   the  dial_\zini;-  memlirane. 

When  it.-  toxicitx'  wa-  delerniincij  hy  iiitraxenou-  injection  into 
animals,  it  was  found  thai  do-r-  exceeding;  from  .^  to  Id  nii;.  per  kilo 
sometimes  resulted  in  .a  -lii^hl  tf.in-ient  alluuuiiiuria.  Smaller  di,-e- 
wcre  harnile--.  -o  f;ir  a-  could  he  a-certained.  'I'hree  m'^.  ]ier  kilip 
w,a-  cho-en  as  tlu'  mo>t  -uilahle  amount  for  our  jmrposes.  I'rolocol- 
of  cat-  and  doi,'-   -tudid!   for  loxicitv  appear  helow. 

ToXK  1 1  ^    I  \ri:i;i  .\ii:n  l.s 
rR'Ti'c  iii.s 

C\T  !  — \\\ii;lit.  2  4  kir. :  given  750  ni;;.  intravenously;  kilUiI  in  tlinr  Imiirs. 

C.\r  2. — \\\ii:bt.  2.75  kg.;  given  "Id  nip.  intravrnmi-ly :  kilKil  in  twenty 
hours. 

C\i  ^ — W'li'jtit,  k".-  ki;.;  iziven  6  mv..  tn  kik'grain  intr.aveniiii-ls' :  i:n  effect; 
urine   free   frmn   .illmniin   afierward 


DiKi  5. — W'cinlit,  "  lig  X'lv.  4,  1''I4:  (mmp  COO  mg. ;  vitally  ^tniiud  ;  iii) 
toxic  manifestation?.     One  wctk  later,  41)  per  cent,  of  (l\e  still  in  circiilaticn. 

Dec.   17,   1914:     lilood   .still  contains  consiilerablc  ilv.-. 

M;irrh  1,  IOI.t-  .\nimal  still  slightly  vitally  staim  d  after  a  period  of  fonr 
iiionth-.  On  only  one  occasion  during  this  whole  period  was  a  trace  of  albninin 
found  in  the  urine. 

Dog  8.— Weight.  6.8.^  kg.     Xov.  17,  l'yl4;    Given  .3.^0  mg. 

Xov.  18,  1'I14:  C'on^iilerahle  alliiiniiii  in  urine;  tm  casts;  some  red  hlood 
celK. 

Xov.  22.  1'I14:    Advanced  distemper.     Urine   free   from  alhiimin. 

Xov.  26.   1914:     Dieil   with  disteuipci. 

Do,;  ').— Weight.  '1.0  kg.  Xuv.  21.  1''14:  fiiven  '■')  mg.  Dog  was  normal 
except  for  a  l:iint  traee  uf  allnunin  fmnid  in  tlie  urine  mi  lir^t  and  --I'eond  clay-;. 

Dog  10. — Weight,  ,^.5  kg.    Xov.  21,  1914:    Given  55  mg. ;  normal;  no  alhumin. 

Til  orck'r  tu  \  itallv  siaiii  tin  ii-^ucs  t-vcti  sjitrlitlv,  it  was  loutnl 
ticecssary  to  ii'C  at  loast  10  m^  per  kilo.  If  a  strong  soltitioii  is 
injected  locally  into  the  subciitaneou.s  tissues,  the  ti-sucs  are  stained 
a  licaiitifi'l  l)rii;lit  red  ccilor,  which  iiersist,  tmaltercd  tor  ir.any  months. 
This  accident  happened  with  patients  on  two  or  three  occasions  early 
in  this  work,  hut  since  has  been  avoided  by  ascertaining  with  certainty 
tli.'it  the  needle  was  in  the  liinien  of  the  ve'iti  'elore  the  cl_\e  was 
injected. 

Traces  of  the  d\e  ;ippe;ir  in  the  urine  ;ind  in  the  Ivinph  llowitig 
from  tile  thiir.icic  duct  at  the  end  of  ten  niimite^.  The  dye  coiuimies 
to  be  excreted  in  the  urine  of  patients  for  from  three  to  lour  days  fol- 
lowing a  (l(jsc  ^f  .S  mg.  per  kg.  Following  this  amount  no  evidence 
of  the  dye  in  the  tissue  cell>  or  white  blood  cells  could  be  found  with 
the  oil  immersion.  I'he  fate  of  all  the  dye  li;is  not  been  detenuined, 
iiul  con>ider,'ililc  amount-  can  be  found  in  the  plasma  for  three  or  four 
days  following  il>  inicclion. 

TI-CHMC 

.\  1..^  per  cent,  -ululinn  nl  the  dve  in  frohlv  di-tilled  water  i>  p,rc- 
[lared  and  sterilized  bv  boiling  for  from  live  to  ten  minutes,  and  nsep- 
licallv  -till  perrd  in  a  sterile  I  .rionnieyer  tlask.  liii-  snluli.iti  is  made 
u])  as  rei|uireil. 

Ihe  patient  is  wcigheil  i-triiiped)  and  the  do-e  dete'rniined  on  a  .5 
mg.  ]ier  kiln  basis.  'I'hc  skin  ove'-  the  anterior  surf.ace  of  both  elbows 
is  cleaned  up  in  the  usual  manner  fur  \  eiiepunelure.  L'nder  aseptic 
teclmic.  ;i  small  platimim-iridium  needle  (20  gauge  I  to  whicii  is 
allaclied  ;i  -hurt  ]iiece  of  rubber  tubing  (  from  J  to  ,i  cm.  in  lengdi )  is 
inserted  into  the  \ein.  Ten  c.c.  of  blood  are  withdr.iwn  iiUo  a  ]iipet 
and  emptied  into  a  ?0  c.c.  centrifuge  tube  containing  iust  sufticient 
powdered  -mliuni  ox.alate  to  prevent  coagulation.  The  pkisma  so 
ol'.tained  i-  u-ed  in  the  ptLiiaralion  of  the  standard  which  is  described 


later.'  Tlu-  nililiir  tuliins;  i->  rL-niovcd  from  the  iicciUf,  tue  latter  liein.i:; 
left  in  the  \eiii  and  a  31  e.c.  Recnnl  >yrini:;e  containing;  the  exact  dose- 
ot  the  (iye  is  attaehed.  and  its  e()ntent^  injected,  after  ^\•hiell  the  needle 
is  withdrawn.  Three  minutes  later,  a  needle  is  inserted  into  the  \  ein  of 
the  oppo-ite  ,inn.  Wiihoul  iniiiedinj,'  the  venous  return,  10  c.e.  of 
blood  art  withdrawn  iniinediately  hy  means  of  a  iiipet;  two  or  three 
niinu'e-  later,  h'  e.c.  more  are  witiidr.'iw  n.  The  lir^t  i.-'  placeil  in  a 
50  c.e.  i-enlrifu,i,'e  tuhe.  the  .'-eeond  in  a  15  c.c.  s,Madiiated  ceiUrifusc 
tuhe.  To  each,  MitVieient  dry  oxalate  is  added  to  prevent  clotting,  and 
the  tnlie>  .are  eapjied  with  rnl)her  to  prevent  ev.iporatinn  during'  cen- 
trifn,L,'aliz,i'Li<jn. 

The  three  luhes  are  placed  in  a  hi,i;h'iiower  centrifn,L;e  and  suh- 
jccted  to  .\0n()  re\()lutions  per  minute  for  twenty  minutes.'  After 
remtjval  from  the  centrifuije,  the  relative  iJrojKjriions  of  erythrocytes 
and  plasma  in  the  .graduated  tuhe  are  noted.  Without  di-turhin.i;  the 
red  cell-,  the  pla-ma  i-  carefully  pipetted  uii  from  each  tube  and  placed 
in  a  clean  test  tuhe.  We  now  have  three  tot  tube-,  (  1  )  contaiuins 
pla-ma  without  dye;  ( _'  and  .i  I  containin,<2;  i)la-ma  with  dye  in  an 
unknown  concentration.  A  suitable  dye-plasma  standard  mixture  of 
known   cl\e  contein   nui-t  be  prepared,  and  with  it  2  and  3  arc  coni- 


The  siaiidnrd  dvc  preiiaration'  is  made  ;is  follows:  0.5  c.c.  of  the 
dve  solution  u.~ed  for  the  injection  is  hrou^lit  up  accurately  to  1(«)  c.c. 


1.  This  procoihire  of  taking  pia-ma  lor  inixiiiv;  llu-  statular.l  in  each  ca~o 
was  louiul  necessary  on  acconnt  ot  the  great  variation  in  tlie  color  ni  ikc  plasma 
ni  (iiffercnt  iniliviiUials. 

2.  Tlie  anionnt  injected  is  3  mg.  per  kg.  The  wri«ht  in  pouiuls  diviileJ  l)y 
elevor.  gixes  tlic  niunhcr  of  cubic  centinu-lers  of  a  1.5  per  cent.  soUition  to  be 
injected. 

3.  To  prevent  hemolysis,  all  pipets  at.l  CLntrifuiie  tubes  must  be  thoroughly 
washed  with  normal  saline  solution  and  dried  before  use  It  is  obvious  that 
tlie  slightest  hemolysis  will  alter  the  color  of  the  plasma  and  make  accurate 
colorimctirc  readings  impossible. 

4.  Obviously  the  standard  must  be  sulVieicntly  intense  in  color  to  insure  the 
patient's  readings  falling  on  the  scale  Since  the  smaller  the  amount  of  plasma 
in  relation  to  the  body  weight  the  greater  will  be  the  intensity  of  the  dye.  a 
standard  must  be  chosen  which  will  be  more  intense  than  the  plasma-dye  mix- 
lure  obtained  from  normal  patients  having  the  smallest  proportion  of  plasma 
in  rt-lation  to  body  weight.  1  be  standard  selected  has  bedi  prepared  on  the 
following  basis:  The  amount  of  drug  injected  is  placed  in  the  number  of  cubic 
centimeters  of  salt  solution  corresponding  to  the  number  of  grams  represented 
by  4  per  cent,  of  the  body  weight,  or,  expresse<l  difTerently,  in  the  amouu;  of 
salt  solution  represented  by  40  c.c.  for  every  kilogram  of  hody  weight:  this 
amounts  to  5  c.c.  (7.5  mg.  of  dye)  of  the  solution  inlccted,  to  100  c.c.  ot  0.8 
per  cent,  sodium  chlorid.  For  example,  a  man  weighing  "0  kilos  would  be  given 
210  mg.  of  dye  (3  mg.  per  kg.),  which  is  equal  to  14  c  c.  of  a  1.5  per  cent,  solu- 
tion. Four  per  cent,  of  70  kg,  is  equal  to  2.8  kg.,  and  without  making  a  correc- 
tion for  the  difference  in  spceilie  hetween  the  hlo.id  plasma  and  water,  tins 
would  amount  to,  roughly,  2,81K)  c.c.  If  210  mg.  are  diss.dved  in  2.8m)  c c, 
then  7.5  mg.  should  be  dissolved  in  100  c.c. 


with  O.S  |icr  cert.  ■-:iliiio.  •  »inj  part  m'  tlii-,  is  iiiixi-d  \\itli  niic  p:irt  of 
the  |.ititiil"s  ;  :  i  and  two  jjarts  ot  salt  sohltidii,  vicliliiii,'  a  dilution 

of  1  in  4.  W;  .  .  lb  solution,  the  prism  of  the  colorimeter  (Rowntree 
and  Gcrajihty's  inndiiication  (jf  the  Auten.ieih-Konigsberger  appara- 
tus) is  filled.  This  dilution  has  been  found  to  be  well  adapted  to 
idlorimctric  deterniiiialicns.  Each  of  the  sjn'cimens  (2  and  3  of  the 
iiaiient's  ]ila-nia  i  i->  diluted  with  thnc  jiarts  valine  and  ii'aced  in  the 
cup  of  th  ■  colorimeter  and  read  ;,,i,'ainst  the  above  standard. 

C:.\LClLATI(l\    ul-   KK.SLLTS 

The  method  described  above  furnishes  volume  \;dues  for  plasma 
and  total  blnod.  When  it  is  desired  to  express  values  a^  ])er  cent,  of 
body  wci,L;ht.  the  formulas  ^iven  bebjw  can  be  utilized.  Since  the 
s]K'cilic  gravities  of  tile  pla.-ma  and  of  the  blood  were  not  ascertained 
in  this  study,  one  of  1.050  for  the  whole  blood  and  of  l.U30  for  the 
]ila~nia  have  been  used. 

Inli.\u;i..\S 

I'Idsimi  i'fluinc. — Weight  of  pati!.-tu  in  kt;.  =  W. 

Standard  prepared  su  that  amount  oi  dye  injected  i~  diluted  in  -iil  c.c.  for 
every  k^.  of  body  weight. 

Reading  of  standard  prepared  as  directed  =  1(HJ. 

Reading  of  patient's  plasma  against  standard  =  R. 

The  number  of  c.c.  of  plasma  in  patient's  Iiodv  =  100/ R  X  40  \V  = 
4.1  iOO  W/R. 

Percentage  of  BoJy  li'eiijhl. — Plasma  volume  in  c.c.  X  Sp.  G.  of  pla-ma/l.OOO 
:=  u  eight  of  plasma  =  M. 

X  X  100/\V  =  per  cent,  of  body  weight. 

Cubic  centimeters  of  plasma  per  kg.  =  Xo.  c.c.  in  body/W. 

Total  Blood  I'olume. — Let  hematocrit  reading  of  the  volmnc  occupied  by 
corpuscles  =  P. 

Volume  of  plasma  =  100  —  P. 

Total  blood  volume  =  iilasma  volume  X   100/100— P. 

Total  Blood  as  Per  Cent,  of  Body  \\'ei(jht. — Total  blood  volume  in  c.c.  X 
Sp.  G./1,000  =  weight  of  total  blood"  =  Y'. 

V  X  I00/\V  — "  per  cent,  of  body  weight. 

Cubic  ccn'imctcis  per  kg.  ;=  number  c.c.  in  body/W. 


VMii;s!K.\i;i.i:   ii:.\TLRi.s  OI"  tiik   .Mi;Tiion 

llciuolysis. — .'sometimes  the  colors  do  not  match  perfectly  in  qual- 
ity. This  is  the  result  (jf  hemolysis  and  of  necessity  makes  the  (|uan- 
titati\e  determination  more  difticult.  It  is  extremely  infrequent,  how- 
ever, to  lind  this  failure  with  lioth  s])ccimeiis.  and  on  the  one  or  two 
occasions  when  this  has  occurred,  the  determination  was  not  attempted. 
Records  have  been  kept  throughout  as  tn  the  matching  of  the  colors. 
In  ,-i  large  jirojiortion  of  instances  the  ef)lors  in  both  specimens  were 
perfect.  Where  the  matching  was  only  slightly  imperfect,  readings 
were  m.ade  and  in  m.anv  instances  tliese  have  closclv  apprriximated 
readings  of  the  other  specimen  in  which  the  color  was  perfect.     In 


sj-ito  111'  the  iiK-l  i-:irvful  tixliiiii.-.  incxiilicalilc  iiciiidlyM-;  (HTurK-d  at 
tiiiK'-.  It  i-  O'iiM.k-i-ahly  ntdfc  fR'i|lK'iil  in  tlu-  iiarruw  Ljraduatud 
cciitrit'iim'  lulir  ii-i'il   inr  tb.c  iRiiialocrit  valiK'-. 

I.il^rui'ui.  l.i|i(.iiiia,  if  \lv\  niarkcil,  make-  tlic  iKlornimati<Mi 
inipn-Mlik'.  <  iiilv  iiiu-i'  ha-  thi<  l)t--oii  cin-otmlrrcM.  In  a  ivw  iii-lancL-- 
it  olTi'n.l  Minic  -hi;ht  ilirtanilty.  I'.y  \>rn\,^v  altiiitioii  tn  ilii'l  aii.l  l<> 
the  time  Hi"  niakiiii;  tlio  (knermiiialinii.  ihi-  cliftk'ulty  can  he  reaihty 
,,h\iale(l.  In  (lur  -erie-  il  ha-  iml  heen  suUieiently  IroiiliK'M.nie  \o 
rei|nire  -leh  niea-lire--. 

I>iSi-,>iiif,>it  tc  l\itii)it.  AM(k'  fnmi  the  -hght  I'ain  nt  the  venc- 
piinetine.  tlie  iialiiiil  n-na!ly  Miller-  nci  ih-ecinldrl  (if  inennvenienec. 
In  aii|ir(i\nnalelv  'i  per  cent,  (if  llie  ea-e-,  ehillv  -en-alion-  (icelirreil. 
wink-  ill  Ir.e  iii-laiue-.  ehill-,  wilh  fe\er  reaeliini;  In  ll'l.  wife  -een. 
X.me  of  th.-  maiiial  ea-e-  e\hihite.l  tliermie  re-iioii-e-.  iliey  are 
appareiith    nmre  e<imniiin  in  ea-i i   anemia. 


I  (IN  ll;(  l.S  el"  Mil'-  MITildl) 
(.'iiiun.k  (111  th(  iiielhiMl  iia\e  hi  en  iiia.k'  in  (irder  l^  (klefimne  the 
I-  taiu-v  (if  il-  liiKhii'^-  liinKr  xanon-  ecnditiMii-  aii.l  in  (.r(k'r  Ki 
jn-lify  eellain  -i  n-  in  ihe  lnhnie,  l  hi -e  -llldii-  are  h,ie  iire-eiiled 
unikr  -iihhea(hiiL:-.  iniilrdk  (Hi  ihe  pla-ma  niethdd  are  lir~l  emi 
-idered  and  later  th..  e  on  ihe  heinaiuerit  ilielhod  of  .kterniiilins4  loial 
blond  \  iihinie 

./  A',//,'  .■/■  n'\s,\p^,\i)iiiiir  of  Ihi-  fi-'Uii  l'l,u'd.  I'hi-()iii;li(nit  iho 
wmk.  na.hnu;-  have  heen  in,i(k-  al  three  iniiiiile  and  -i\  minute  inter 
xal-.  Till  f.dliiwiiiu  alford  -tiikini;  ]in".l  of  ihe  -l.iwiu--  with  whi.h 
the  d\i  i|i~appiai'  fnmi  the  eniulalii'ii  In  i  -i  i  ie-  "I  ihirly  d\ 
ea-e-  ill  whieli  the  mliir  iiiatilnni^  \\a-  ei|naily  jmmhI  in  hclh  determilia- 
tidii-.  nine  ea-e-  -h"\\ed  iilenlual  readiii!.;  fcr  llie  twn  di  li  i  nun  ili(  itis. 
nine  .Imwed  hii:hir  reading;-  fur  ihe  -eeiii'd,  llic  a\i  ra-e  anii.nnl  ahdve 
the  tir-l  heiny  I'r  ]'er  eent  .  while  eiuhlien  dinwe,!  InLlhei  r'a(hn;4-  lur 
tlie  In  ~1  detenuinaliiMi.  the  a\iraL;i  anicuni  ahcM  llii  -iidid  heini,'  .1 
]ier  lent.  I  hi-  iiiduale-  thai  -nine  d\e  dee-  di-,i|ipear  I K  >m  ihe  i  ir 
eillalidii  (Iiiiiiil;  llie  lime  "f  diU  rminalii  m,  hut  al-n  in. hi  ale-  that  ihi 
III-,  1-  HI,  ..ii-lanl  and  -mall  '  hi  rare  (Hia-Kni-.  maiked  di-ire|ianeics 
in  ihe  \\\n  reailinu-  (Haur  ^m  h  del'  1  ininal  1..11-  -hdllld  he  discarded. 
I'.eldw  is  shown  the  r,il(  d  di-appe  iraiice  dl  ihe  (i\«  fn.iii  pla  nia 
in  a  mail  <i\er  a  periml  cf  iwilve  niiimte-.  readinu-  hemi;  m.,di  al 
approxitll.iIeK  1  ud  mniiite  inli  r\al-,  .md  I  in  amniml  of  d\e  <'\  liie  lirst 
di-t<Tniinalidii  heiiii;  lon-idiiid    1""   per  eiiil. 


» 


I  I  • 


» 


J    C,   u(if;lit  55.4  kg.;   178  nij,'    dye   injectcl. 
Time  l-'.lap'-ing 


4 
6 
8 

10 

12 


Pir  Cent. 

....  100 

104 

103 

102 

102 

''7 


luHr  of  Pisi!fpi\iiaiu-r  uf  Pyr  from  the  C  cuhitioii  in  /'.i.;.v,  I'ro- 
luiiil-  1  ami  2  indii-alc  tlu'  -Inw  r.itc  nf  ili-.i|iii(.'arancc  of  (l\r  frciii 
llic  MihmI  (if  iluM-  the  aHiHunt  lUT-riit  on  tir-t  (Ictcnniiiatioii  luinj,' 
foii^idfix-il  a-  11 II I  iicr  cent. 


Dill,  I.  -W'ligl.t.  7  7  Kij.;  2.1  mg    d.M   iiijiiiid. 
Time  Iilap>inR 
Hour;,  Minutes 

13     

30     

2  20    

3  

•   6  

24       ; 


IVr  Ciiit. 

'n 

i)2 

65 

60 

52 

26 


Uoi;  2.— Weiglit.  ''.5  kn  ;   \''0  me.  ilye  injectcM. 

Time  I^lapiiiiiK 
Hours,  Minutes 


* 

10     

, 

12 

, 

15 

1 

(i 

1 

s 

I'er  Ci'lit 

Sii 
SI 


"3 

Tlie-r  (lata  lUiiion-liMle  ill. it  llii  aKMiriitjoii  from  tin  liloo,!  -trr.im 
i~  >l(i\\  .  .111(1  m-lif\  11-  111  an'e|(liiiL;  (IcUi  illill.il  i(  dl-  ni.idi-  williiil  -i\ 
niilimt-  ((f  the  lillli  of  inintioll  of  llie  dvr  1  llllliil  ](r((((l  (d  tile 
-lowiie--  of  lln'  ali-((r]'li((ii  i-  -liowii  li\  llir  l.i't  tliil  n\\  -imimI  i)cc;i- 
-jod^  tlu-  )(1  i-ni.i  ill  111    to  f((iir  (la\  -  ,ifur  tnie.  lioii   -li((\\i  (1  a  i  oii-ickT- 

;iMe  ai ml   ol    llir   (Ui         II  '    illi'u    .il-o   -liow-   tl.m-    lor   -((llir   d.'N - 

after  llic  iiiie(lioii 

/:  i'iiliirs  loiiiii!  on  A'i7'i((/('(/  Pi-t,-i  niiiiiititiiis  lselie.Hi(|  deltr- 
mm.ilKdi-  .(||  llie  -.iliie  indi\idll.d  vieM  pi ,((  tu  ,dl\  idiiHi.  'I  re--nits, 
|,iii\  i,l(  (1  11(1  .i|(|(M  (  i.ilile  ,  liani;e  in  llie  iialieiir-  (  on(|itioii  li.(  oo  lirred, 
>nnie  ol  llic-e  pel  ( (11-  are  IMdm.il  .ind  (dlh  1  -  .He  -lllli  1  llli;  I  idll  i  ar((llic 
ilisea-e  m  \\lii(  li  no  .ippreeiaKU'  <  li.inue  o(  (  iirie(|  dm  in-  ilie  ml<  run 


5.  The  first  rcailinK  nt  two  inirutci  was  lower  than  siiliscqucnt  ones.    Mixing 
was  protialily  not  eimipKii'  m  tun  iiimnti -. 


8 

TABLl".    1  — Ri:pi:ati.d   DktkkminaTiONS   on    Mkn 

Cubic- 
Snim'  Date  Woight       Volumi'         ccnti- 

in  e.c.         meters 
ptr  Kg. 

CI 2;  2,15  M  2.I122  50 

2,   4  15  OS  J.ii:iil  ;V.' 

Fl  .  2'  2  15  <'.;  2.!«;'.i  41 

2  4  15  lit  3.037  t:, 

|.  3  1115  57  2,(ai5  47 

3  12  15  67  2.liM  17 

r,  3  1115  M  3.171;  r-o 

3  12,15  M  3.0S3  4.- 

U    1'  7,15  61  3.03«  4!i 

2,'  li  13  04  3,11)5  lU 

T 2  •215  50  1.H75  4u 

2, 25, 15  50  I.IW  4U 

Kr  120  15  (VJ  3.0.V1  411 

3  18,  15  t)3  3.I(iO  50 

I      ,  1  12  15  81  3.172  3il 

i,'  3,15  N)  3.0ii4  :» 

w  4,22,15  1-4  r..:',r,  ,^3 

6/  S/I5  '..-,  ".1'-'  ."3 

1  )(iy-  lid  iKil  L;i\f  -o  ri.ii-laiit  ii-iill-  liiit  il  i~  all' i^llii  r  innliahlc 
ill, it  llu'  ilii^-'  ],la-ni:i  \(ihiinr  i^  -iiliU'it  I'l  r''lali\cl\  i;ri.attr  .iml  ill'. re 
-U'l'Un  iliaiiL;i-  lliaii  ili.al  of  man.  ."^i.iiic  inuri.>li;i^'  lindiiii;-  uu  dw^i 
ail    itU'l:iiK(l  in    I  .alilf  J, 

T  M'.l.l-'.     2 — RllMMIIi      III  1  I  UMIN  \  I MN--     (fN      I  )(ir,S 

riiiMii::,        Ce,  per 
.Nil,  liuir  WciKlil  c.l'.  Kc  UiiiKiiLr 

1  1  l:<  111,,'.  (Ot  911.3 

1,27  ■'    :".  (12S  mii  |ii.|.lii|.iT 

2/  1  ,■•  1  ,-.72  70,1. 

2/  a  7.I1S  4D1  02,'-  I'.illiiKinK  immnllnK'lv  a  lili'edlng  til 

11;:.  tvc, 
1/  4  T.BS  lal  S55  Ni-,\t  liny 

l»8  120  .\((iT  infilrliill  •>(  32'.  11 

2  1  2T  ».(»  OOS  tKl 
■  15                   U.02                  033  111 

4  1/11)  15  1.202  Ml  lilnifiuirtT      bliil  .iMi  le.  »is  iMlniilf* 

Itefuro  tint  fiainple 
1,'21  15  1.137  70  4 

(  .   I'ht.uuti   I'i'liiiif,-   /  'rli-i  iiinu-il  T>  i//(   rinviiii  .liiu'ioil     of  P\r. 
'I'lio  '..■inu'  \;ilii<'  fur  lilnm!  \(ilii!iu    1-  ulit.iitu.i  \\liillnr  im".-  wmk^  willi 
J.  .?  1.1    1  Ml:;    I'll   kill. '^r.ini       I  lua  <   |ir.i.  li.  .illx   ninin.il  nu  n  w  <  n    -Uiilu.l 


• 


in  tlii>  coniKclicin.  I  Jiicniini.itinn--  mailc  after  injection  ni  2  and 
.^  nit;.  (IdNC--  yic'liif(l  \ahii.'>  within  7i^  c.c.  in  two  instances,  while  in 
the  tiiird.  J  and  -i  nij,'.  per  kiit>L;rain  were  used,  the  resuUs  agreeinjj 
within  I  per  cent.  Three  nit;,  per  kt;.  is  ciinNidered  nbscjlutely  ^atistac- 
ti^ry,  xu'liUnt;  culur^  well  adajited  tn  culcirinietric  determination. 

/'.  ('I'Htruls  till  the  Colmiiiicti'r.  In  the  jja-t.  in  niakini;  ]iarallel 
-•eric-  of  reaihnL;-  witii  \ariotis  phtiialein-  and  with  l''ohn'>  niicro- 
isji'ldahl  nuihod.  practically  identical  reading;-  were  obtained  with 
iwci  in-tniiiient--,  the  linlio-ci|  and  our  colorimeter.  In  a  >niall  -crie- 
of  ]iarallel  reacliiiL;-  made  in  thi>  investigation,  identical  readini;-.  were 
.aNo  (ilii.'uneii  with  both. 

/;.  'I  It,-  /.'M-.v  (i/  I'ltiiu!  at  rnirsrctiiiii  /''LHUiii.itidtril.  The  nicUiod 
\\a-  applied  to  three  men  before  .ind  after  phlebotomy,  ihe  re-illls 
appear  in  1  able  .v  \o-  1  and  _'  were  normal  donor-  lor  Iran-fn-ioii 
and  Xo.  ,1  w,i-  a  hypcrten-i\i'  p.atient.  the  -nbjcct  ol  .i  ihcr.ipetitic 
\ene-eclion," 

T  Mil.H    3. — Lnss    MK    Bi.iion    at    Vi  msictihv 


Xeme 

Volume  Bctore 

Amt.  Bled 

Volume  After 

1.   (i  . 

l'I;>siim, 

3.180 

SIX) 

riiifliin. 

2.S«2 

•:.   ii 

I'liisin.i. 

e.Tao 

620 

Plasma. 

;,:t3 

Bli.o.l. 

.i.osa 

Bloud. 

4.2T4 

3.    A.  . 

I'lil-illUl. 

3,STL' 

SOO 

rin.«imi, 

:i.cri 

Ill 1. 

li.U.I 

lil.i,,.|. 

.434 

A  dccua-c  corr( -ponding  t.uilv  well  to  the  aniolliu  of  blood 
rcniii\cd  i-  d(  nion-tr  lied   in  ,ill   ihrcc  cases. 

/■  I  Iriihil.u  I  :l  The  wlioU-  IiIihhI  \cilnmc  i-  c.ilciilated  from  the 
[ilasina  \ohime  on  ihe  b.i-i-  of  the  1  .'m.iiocni  tindiiii;-.  .ifiir  ceil- 
triftlRali/.ition  ni  !,'radn,ile'!  tnbe-  for  ,\<kk)  re\ohuion-  per  niimile  for 


» 

• 
• 

twenty  minnle-      A  longer  peii".!  \\,i-  nnnei  c--ar\ ,  llie  p.ickiny  .ilw.iv^ 
re.ichini:  il-   in.i\imnin  within   tin-   nine        The   \.ilne-    from  the   -,ime 
individn.d    v.iricd   bin    litlle.  whclhcr  ihc    -.imples  were  obl.iined   with 
lice  circnlalioi!  ol   blood  or  .iller  inipt'dinLT  Ihi'  \inon-  nturn   for  a- 
long  ;i5  lifleeii  miiuilc-.     When  llie  Miioii-  return  w,i-  ml  olf.  ihe  red 
cells    increased   4   per   cent.    ,ind    .^    per   cent,    in    two    in-i,ince-   .ind 
decreased  2  j)er  cent,  .and  .^  per  cent    in  U\o  other-      Wlnie  po--ii)le. 
it  is  better  tj  take  sample  lur  heiiuuocni  determination  from  the  freely 

• 

6.  The  Litulcm.m  mctlioil  of  traiisfifinn  was  ii'cil  and  the  amount  nf  hlood 
niMSurcil. 

• 


10 

cin-ulntint,'  IiI.hhI.  Rfin',iU-<I  .UtcrniiiiaU(>n<  im  ihc  same  normal  \u<U- 
viihial  t;i\r  v!n-c  Inil  ii.ii  iikntirt  il  valm-.  rnd.'ulili'dl)  --m.'  uvyvr- 
timil\-  fir  ■  rrnr  i-  lu'rc  all^rcUd. 

(,.  Is  llir  /'\v  l\i,..-ni  I't  /'•,  llir  h'^'i  !'!>'<"l  d'lls.'  I'-arly  in  the 
Cdur-r  nt  ihi-  work  it  i.r.  aii.e  e>.iauil  that  ihr  dvc  wa.-  iini  rcadilv 
taken  U].  kv  ti--ne  erlK  nr  tlie  .-ell-  in  the  l'k"'l  -treani,  iMan,!  ike 
fN]ierimem~  with  eulkHhini  -ae-  in-e\i(mdy  mentuMK-.i  an.l  I  rum  tke 
faet   tlial   neilkrr  ilie  er\tkrne\u-   nn,-  irnknevle-    were   -lained.   when 

nkM-i\e.l  in    (re-h   hi 1   i.rq  arali'in-,   it   -ernieil    fair  U,   -nrmi-e   'hat 

most  nf  the  ihr  ninanie.l  in  the  pkiMna  .Inrinu  ;lu  -Iiorl  lime  oi  the 
(lelerminati.ni.  In  "ulrr  to  u:<'l  at  llu-  (|nr-linn  (|nantnati\  ely,  it  was 
lir-t  ne>a->ar\-  to  ik.terinine  ihe  rrlaio.e  amiuml-  oi  ]il.i-ni,i  ,in.l  veil 
hloi.il  eurpttMle-  in  tke  wlmle  IiImm,!.  Se\eral  metko,]-  ha\e  keen 
cm|ilii\eil  lor  thi-  pm-]iii~e,  amonu-  other-,  the  \ariou~  form-  m  the 
liemaluen;  .nal  the  nilro!,'eii  mellunl  ile\i-eil  ky  k.Kiklren'  I  ho 
hematoeril  metko, 1  de-eriked  ahovc  was  loimd  tn  he  tke  nrnM  -ali-lao- 
lurv  fur  our  liur|io-e.  \ie!dinL;  li^itre-  that  agreed  eki-il)  with  those 
(ihlained  hv  other  wnrker-  uilk  iki-  melkod.  In  two  dillrrenl  -anijile- 
of  kluod.  tile  relative  aniolint-  oi  |.la-ma  and  erythriKXU-  wrre  deter- 
mined kv  llie  kemal.ierit  and  ky  tke  nitro^m  method.  Ihe  latter  ,i;ave 
a  lila>ma  \alue  4  Jier  eeiit,  t"  "  per  emt,  hiuher  than  liial  ot  the 
liemaloeril  i'deihlrelt's  liuma-  were  .d-n  kiuk  enni]iar'd  wnh  iki-,  ,,i 
dlher  iih-erver-  iimul;  the  hemaliiein  melhud.  In  nnr  wirk".  tke 
hematoeril  value-  only  were  taken 

In  onler  to  delerminc  whella  r  llr.  ii\e  i-  ak-oiki-d  h\  the  kinod 
eell-,  and.  if  -o.  to  what  extoil.  the  folliiwin-  iivoeednre  wa-  ad.Mi.ud: 
I'ifty  c.e.  of  blooil  were  taken  from  a  lieallhy  man  and  rendered 
incoai;ulnl)le  with  jMnvdereil  sodinm  us. date.  Ten  ...  ni  tin-  hlond 
were  ll-ed  for  hemaloirit  ik  lerniinalion,  15  e.e.  heini:  eeiilrilnued  and 
the  pla-nia  pijietled  olf.  Ihe  remainder  wa-  ai;ilaled  mitil  mea-Uied 
out  for  the  exiieriilieiils  i;ivcn  helow  : 

lixfi-rimeiit  i.— CcntrifiiRc  Tiilio  1.  liiiLcn  c.c.  of  lliis  wlmle  Iilooil  pus 
2  o.e.  of  live  solution  pli'S  13  c.c.  of  saline. 

CentrifiiKC  Tulie  -'.— Five  c.c.  ot  plaMHa  plii"  1  c.c.  of  dye  sclutioii  plus  4  c  c. 
of  valine. 

After  Tiilie  I  \v;n  ctntrifntjalizcil.'  llie  pl.Tsnn  was  pipetted  olT  and  coin- 
parol  with  llie  plasma  ilyc  mixture  from  Tiilie  2,  which  was  placed  as  the 
standard  in  pri-iii  of  the  colorimeter.  The  readiiiK  was  80.  Therefore,  in  dilu- 
tions used.  Tiilie  1  contained  Wl  per  cent,  as  much  dye  per  cubic  centimeter  as 
Tulic  2.  The  relative  amount  of  plasma  in  the  blood  in  Tube  1,  as  shown  by 
ihe  hemalocril.  is  fiJ.S  per  cent. 

Then  IS  X  (>ii  =  9-37  c.c.  plasma  in  Tube  1. 


m 


7.  nieibtrcu.   M.   ami   I..:     lane   Mdhode   xur   RestimniunK  dcs   Vailiinis   der 
korperlichen  Klenieiite  im  Itlut,  .Arch.  f.  Physiol.  (  rilJuer's  l,  IfWJ,  b,  151 

8.  Three  thousand  revolutions  per  minute  f<ir  twenty  minutes. 


11 

Then  2  c.c.  of  <lyc  solution  is  ililulid  in  24.,^7  c.c,  or  1  c.c.  in  12  18  cc. 

l)r  there  slioiild  be  10/ 1  J. 18,  82.9  per  cent,  of  dye  in  Tube  1. 

Colorimeter  reading,  as  calculated  from  hematocrit  data,  82.9  [icr  cent. 

Colorimeter  reading  observed,  80  per  cent. 

Ext^erimciit  2. — Experiment  1  was  rcpcatid  with  tlie  Miu.rl  t.ikm  frnin  another 
normal  individual. 

Colorimeter  reading,  as  calculated   froni  hiui.-it..crit  dat.i,  SI  .'^  ptr  cnit. 

Colorimeter  rcailin.g  o!i>civcil.  Si  pt  r  cent. 

Ex/'criiiictit  S. — E.xperinient  1  was  repeated  with  the  IiIih.iI  t.ikrn  I'r'in  a  tliird 
normal  individual. 

Colorimeter  reading,  as  calculated   t'rom  lKniat"crit  data.  814  lur  cent. 

Colorimeter  reading  observed,  81  per  cent. 

Ill  coii^-iilcriiii,'  the  fia'cyniiii^r  v.xiicriiiuiital  ilata.  several  tactors 
slieuiM  I'c  iiciicd.  riic  lictiiali  icril  iiiit-t  iicce^^arily  ;;i\c  ti>  the  iiiiiii- 
mtiiii  vahic  for  llic  ainmiin  of  iila--nia  in  the  hlooil,  a^  the  eiir|ittseles 
,ire  wet  and  tlie  iiiter-lices  are  filled  with  tlitid.  Therefore,  the 
hem.-iloerit  lliidiiij,'s  for  plasma  imi-t  be  slightly  low.  and  the  ealeulaled 
eolorimi'ter  rcadiiii;  sliyhtly  lii,i,di.  If  tlic  dvc  is  alisdrbi'd  liy  or  dilTuses 
into  the  eor|Jtl-ele-,  the  oli-er\ed  colorimeter  ie:idiii,L;s  will  he  low,  that 
i-,  the  iil.i-m.a  Mihime  lar<;e.  .\s  the  ealeulaled  atid  observed  litjttrcs 
ai^ne  x i  <losely,  the  .-iniottiit  of  dye  lost  troiii  the  plasma  iiiii^t  be 
ne^liuihle.  Irnm  the  foret;oin!,''  exiierimeiit^,  it  wmild  ~eeiii  -^ale  to 
c(inclui!e  di.tl  in  \iiro  little  nr  none  nf  the  d\e  ]ia.-^es  into  the  blood 
eelN, 


Ki  I.  \  I  n  i.\  oi' 


"■|i    ,\Mi    l'l.\s\l\    \"l.l    .Ml.     lo    III.Miili    PKI  ssft^I-: 


\l  the  -tiL;L;e^liiin  ui  1  ir,  lanew.iy.  e\|ieriinenl ~  were  carried  out 
to  ascertain  what  iIIccIn  cb.inm^  in  the  caliber  n\  ibe  -mailer  blood 
\e--el-  li.i\e  on  bldod  and  pla-ina  \i'lttme~.  \i'lttn;e  determin.ations 
were  in.ide  nn  dni',  all.icbeil  to  .i  kMinn^raiih.  I  he  traeini,'>  with  the 
blood  v.iltte-  ai'pear  in  l'ii;itrer.  I  .and  _'.  The  x.isocon-trietion  was 
obtained  b\'  eoiitinitou^  a(ltnini--tr,ition  of  (  pineplirin,  ;i  fairlv  e<itistatit 
le\(l  beinL;  mainl.iin'.d  lor  !i\e  ininttte-.  In  each  detennin.itmn,  before 
inpclini;  the  d\e,  pl,i-m,i  w.is  removed  for  the  •-l.ind.ird  and  within 
;i\e  minttti  allcr  the  inieciicn  tlu'  ■  imple--  wiTe  withdrawn  for  the 
\olnttie  e.-timalioiis.      I  he  dot;-  weighed  14. ,i  .md  12.7  k'^.  re-peetively. 

\o     irikin'4  eb.niL;e   in   bh  n.I   di'   pl,i-nu;   xuhmie   ,icci imjianie.!   the 

f:iirl\-    in, irked    \  .irialinn--    in    bliMid    pies-tirr        llnwexer,    tlu'-e    hi 1 

pte>--nrc  cban'.^e-  were  ni  -burl  'Itir.il i' 'ii. 

JJr.  I'.  IJ.  i.am-iiM.'  wiukin^  in  Mr.  Xbel'-.  l.ibi'V.iinrv.  b.is  liiund 
that  the  polycylhen'.ia  which  de\-li:|i--  .ifler  epiiupbrin  iineclion  doe- 
nut  ri  acb  It-  inaMinnm  fnr  finni  linieii  i..  l\\cnl\  in'mUe-  NUlnme 
drieiinin.ilii  in-  ni.ide  "ii  two  iln'j^^  .liter  tin-  inler\.il  -Imwcd  a  .-!i;;ht 
bnl  (Kiinile  deciea-e  m  pla-in.'  \ulnine. 


9.  Personal  cotmminication. 


1 


f-i   00   ^ 

lA,     CJ     « 


c^  aa  cc 


i 


fr 


CO 


i 


C       C  1 


14 


# 


mi;tiiiiijs   rki:vicK  sl.^"   i;.Mri.MVi;ii  aM)  \  \i.ri:>  hihaim;!! 

Ai'cordini,'-  to  \\'(.lcki.'r,'"  iIk-  carlit'st  altcmiil  to  dctcrniinc  the 
IjIuoiI  \oliinic  was  made  liy  Ilaller."  It  i,iin-i>ttjcl  of  bleeding  t.vo 
criminals  to  <kath,  the  nmonnts  of  hlood  ohlaineil  lieing  28  and  39 
liotinds. 

The  methods  tall  into  two  general  groups,  only  those  of  ("iroup  2 
being  applicable  for  clinical  ]Uirposcs. 

1.  l>in\-t  Method. — Welcker,  in  1S54,  bled  aninial<  to  death, 
washed  out  the  blood  vessels  with  water,  minced  and  washed  the 
tissues  thoroughly,  brought  the  blood  and  wa-hing^  togelher  and 
detcrniined  their  hemoglobin  content,  lie  concluded  that  the  blood 
constituted  one-thirteenth  <if  the  borly  weight  in  mammals,  .^hortlv 
.alter  tliis,  ]'.i>c]ioll '-  ;qiplied  tlii--  method  to  two  criminals  .and  obtained 
the  same  \.ibie.  .Modificiitious  of  the  method  were  ma<le  b_\'  lleiden- 
hain'-'  and  by  I'le-cb.  '  A  similar  preliminary  jirocedure  was  u^ed  by 
t^'ohnstein  ami  Zunl/,"  the  calculations  being  based  on  cell  counts 
instead  of  hemoglobin  c-tim.ition>.  and  b\'  Kottniann,'*  who  emplo\ed 
the  hematocrit. 

2.  Indirect  Mrtlu'ds.-  \.  Infn-ion  metlio.l  :  i  ,;  i  llirb-t,''  in  1S22, 
injected  the  \,i-cular  <y--lcin  of  a  cor])se  until  the  \essel-  seemed 
moderately  tilled.  (  /) )  \'ierordt'^  experimented  on  animals.  1  le  deter- 
mined the  .amotnit  (if  blood  jntmped  from  the  he.irl  in  one  second  .and 
multiplied  this  by  a  number  corresponding  to  the  seconds  recpiired  for 
a  complete  circulation.  <  )n  the  b.a^i '  of  certain  calcul.ations,  he  con- 
cluded  that    in   man   the  blood  constituted  one  thirteenth   of   the   bodv 


10.  Welckur.  H.  ■  Bcstimniunscii  ikr  Minuc  (li,s  K..riHrMiiti-  und  dcr  Bhit- 
tarbckr.Tlt,  souic  Botimimiiigcn  von  Zalil,  M.i.tss.  OlicrtlaLlic  mid  N'cilunuii  dcs 
(.in/cliK'n    Eliitkiirpcrclicns   hciin   Tliicr   mid   liciiii    Mcncluii,    I'r.is^cr   \"rtli-chr.. 

1554,  iv.  11;  Ztsclir.  f.  rat.  Med..  18.^8.  iv,  145. 

11.  Qiiot  d  from  Welcker   (  N'ote  10  i. 

12.  r.iscliofT,  L.  \V. :  Bestimimint;  di.r  lllmmcnui-  lui  ciiKiii  1  hni^Lih-litcn. 
Ztsilir.  f.  WisseiT^cli.  Zool.,  1856,  vii,  3M  :  ,\lieriii:ilii»e  Hoslimmmi;.;  dor  Bliit- 
mengc  lui  eincm  !  liniacriclucteii,  ibid..  1858.  ix.  65. 

13.  lU-idetili.Tiii :  L'elicr  die  BIiilincnKC  ikr  Siingct'.iicrc  init  hc?ondorrr  Riick- 
sicht  aiif  Welikcr's  Mcthoilc  der  Bkitbcslimmmic,  .\rch.  f.  plivsiol.  llcilk,,  1857, 
n.  f.,  i.  507. 

14.  rioscli.  I.:  Ibiniodvnumii-.lu'  Studicn.  7t-o!ir.  f.  ixpii,  I'alli  ii.  Tlicrap  , 
1509,  vi,  380. 

15.  Colinstcin  and  Ziiiil/.  X.:  I'litrv^iirlimiReii  iibci  den  MiiSsigk^'it- -AiHtaiiscli 
?wisclK'n  Bliit  mill  Gewelien  imler  verschicdciicn  pliysiolofii-chen  mid  pallio- 
logisdicn   BcdiriKmiRfii.  .\rcli.   f.  Phy-iol,   (Plluger's),  1,888,  xlii,  .W. 

16.  Kottniann.  K  :  Ucbcr  die  Bcstimmmis  dcr  Bkitmcnge  bcim  Monschoii  iind 
Tier  iinlcr  .\invcnckinK  cities  neiicn  Prazisionsliactnatokritcii,  Arch.  f.  exper. 
I'alb    11.    I'liarmakol..   I'Wi.   liv,   ,'.-(.. 

17    'Jiir.tcd   from  Wrlckcr 

IS  \'iernrdt.  K. :  Dns  .AbbiiiiRiskeilsRc^etz  der  mittlereii  Krei<1aiif<7citen 
vnn  den  niillleren   Puls-frcqueiizeii  dcr  Thierartcii,  .\rch.   f.  physio!,  lieilkuiulc, 

1555.  11    f    ii,  527. 


• 


•' 


15 

wci.sjht.  (c-)  \'ak-miii'''  reiiKJVeil  a  (ki'iiiitc  aiiiouiil  of  blood  (a),  then 
injoclcd  a  known  amount  of  water  into  the  va>ciilar  >\>tciii  and  bled 
a,i,'ain  (bi.  The  >()lid>  of  a  and  b  were  detennincd,  the  difference 
hein^'  due  to  the  number  of  cubic  centimeters  of  water  injected.  \\  eber 
and  I.ehmanii,-"  utilizing-  tiiis  method,  concluded  that  the  blood  con- 
>tituted  one-ei,L,dith  of  the  body  weight.  ((/|  Quincke-'  utilized  the 
method  of  Malla--e/.--  Red  couiUs  were  made  in  ca-e-  of  ])ernicious 
aneftna.  A  kiii>\\ii  amount  of  blood  with  a  known  cell  count  was 
traii-fu-ed.  follnwini,'  which  tlie  ])atienl'.-  red  celN  were  a^ain  counted. 
From  the-e  dat.i,  the  \(jlume  was  calculated. 

1!.  Inhalation  Method:  (irehant  and  Or  |Uaud-'  .ijave  doi;s  by 
inbal.iticm  :i  nie.iMired  Milume  of  carlxjii  UKmo.xid  and  deternnned  it- 
liercer,ta,i,'e  content  in  a  -m:.II  >:un]ile  of  the  animal'.-  blooil.  I  laldane 
ar.:l  .'^mith-'  modified  thi-  mcth<id  an<l  .-ipiilied  it  clinically.  '1  he 
jiatienl  brealhes  for  ti\e  minutes  a  mea-nreil  (|uantily  nf  carbon 
niiinoxid  from  a  s|)ecially  de\  i>ed  apparatus.  A  .-.ample  of  bI(jod  is 
remined  .and  its  carbon  miaidxid  c  njent  e-limated  by  the  carmin 
titnilion  method  of  llaldane.  I'le-clr  ;nid  t  >eruni-"  have  em])loyed 
this  uiciIkhI,  but  the  former  determined  the  carbon  monoxid  volumet- 
rically. 

('.  .\ntil(ixin  Method;  I'.ehrinii''  noted  that  tetanus  antitoxin 
remained  in  the  circulaticm  for  lon^  periotls  and  made  this  the  basis 
fur  the  e-timatinn  of  blood  \olnme.  Ili>  .-Indies  showed  the  blood 
to  con-titiite  1  ll.S  of  the  body  weight.  With  it,  Kammerer  and 
Waldmamr"  in  MnllerV  clinic.  olitaiue<l  a  value  of  1  lO.J,  while 
l-'ries-"   found  a  value  of   1    l_'.fj. 


1<).  Valentin.   G, :     I.ilnl.iuh   .kr   Phy-^id'i  l;!.',    !S47.   i.   4".i 

Jll.  W'Jmt.  I-:,  aii'l  I.rhinami.  C.  (i. :  Lclirl.ucli  lUr  iili> -i'i!.]gi-rlic  Cheiiiie. 
1S.=II.   li,    .Xullam-   ii.   -'.-''. 

Jl.  Qiiii:okL';  WVitirc  lkijbaclitun;;<n  ul'cr  prrni/iose  .Xnainic.  l)oiit-cli.  .Xrch. 
f.  klitrMeil..  18",  XX,  27;  rcf.  Plcscli. 

",  Mala'.sez,  L. :  Xouvcaux  proci-ilrs  puur  appii'cier  la  nia--c  lotalc  da  sang. 
.\icli,  ck-  pli\siol.  norm,  ct  path..  1S74.  vi,  Seric  _'.  7''7. 

_M.  (jrcliant  aii.l  Qiiinqiiaif', :  Mc^iire  (hi  M'lumc  ilc  saiiii  ooiitttiii  ilaiis 
ror!;ani-nif  il'im  M.iiiimikr.'  vivant.  C  iinpt.  Kcik!.  .\cacl.  Sc.  1882.  xciv,  1450. 

24.  Ilal(kinc,  J.,  and  Smith,  J,  Lorrain  :  T!ic  Ma^s  and  Oxyscn  Capacity  of 
the  Hlood  in  .Man,  Jour.  I'liysinl.,  IS'iQ-l'idtl,  xxv,  .?.M.  Smith,  J.  Lorraiti  •  Dis- 
i-ii--ion  in  the  lilood  in  Disease,  Trans.  Path.  Soc,  London,  l^^OO,  li,  .Ml. 

J.^.  ■rarohaiinff.  J.  R. ;  Die  Be-timininiK  der  RlutmenKe  in  kliemlen  Mcn-clien, 
Ar.h.   f.   riiysiol.   (  Pllnser'sl,   1880.   xxiii.  54,>^ ;   1881,   xxiv.  .-.'.- 

_'(i,  Oiium.  lb  1'  T. :  (JuaiUitatne  IMiitiintrrsiuhunKin,  Dciit-eh.  .\rch,  f. 
klm     M.'d,.   l'-08.  xriii.  .W' 

27,  v.  Ikhrini;.  I-",.;  Die  .\ntitoxiiiniet!iode  yur  liUitnuimr  r.c-liinniun.i,', 
Minuiun.  incd,  Wkdinsclir.,  1011.  Iviii,  65.^. 

JS,  Kamnirrrr,  II  .  and  '",  .ild.Tn.inr.  .A  ;  I'.iiilnunL'i'lii'-timnuinncn  naili  v. 
lltliriuL;  mill  :uidii-e  i|n.iiililalu  r  unur-iiidimm.ii  (kr  l'.hitlie-.taniltcilo.  Dcnt-idi. 
.\rili,   f,   klm     Mol..   I'd. I   nx.  ,-J4 

2''  I'm-.  II,:  I'rlur  \k  i  anddimmii  di  r  I'.liitinriik'e  in  Si-Inv:!n};erschalt, 
C.l.nii    mid    W.ulirnk.rt.  /.l-.hr.  f    Geh.  n    ("i>ii.   I'dl.  Ixjs,  .^40 


• 


16 

Tabltj  4  indicates  the  wide  \ariatinii^  tliat  lia\e  Iteeii  obtaiiR-d  liv  the 
(HtYereiU  methods.  Tlie  total  niimher  ct  normal  eri^e^  has  heen  >maH. 
In  t!ie  re]>ort  of  Haldane  and  Smith.-'  the  Hniits  for  normal  are  very 
wide,  ihey  ^tate  sjieeilicallv,  h(jwe\er.  that  one  of  the  ea-^es  was  verv 
obese,  that  i-^.  the  one  in  which  tlie  blood  was  only  one-thiriieth  of  hi< 
bodv  wei<dit. 


TABLK   4.— VAKiATinNs    tn*    Blood    V^oiumk    by    Difffrfnt   MiTimn.s 


MeiliiMl 


IV  r 
No.  of  I  xtrt^inp        Avor-        Cent 

Cases         Fractions        age         Body 
Weight 


Ri'iiKirks 


Hal!,  r 


W<i\  ti.  .lo:itli:  \MiEtii 
i.f  bloo.I 


Wclckor  ;iDil      Hl-'I    ;ind   ua-!i<'.|   out 
liiMlintl  v.'-M'is   uf   criminals, 

t'oiiipart'd  with  hem 
at  in 


lll.til  i:.4        1  13 


•24-."0  pounds  (•i 
hloofi.  Body 
wt.  not  givi'n 

This  was  arcep- 
tPd  standard 
from  is:>s  to 
ISSl 


Taichannw'  SuiMtintr  and  coimtini: 
K.  B  C.  and  llh. 
before  and  aftt  r 
sleani  b:.th 


1  n.T  I  21.8        1,15 


Viornrdt  Nn.    v.c.    put    nut    by 

ht.Mt  miiltiplii'd  by 
No,  of  M'con'Js  re- 
quired for  lunipltte 
eircuJation 


1/13 


W  o  r  k  (^  d  (>u 
)i  o  r  s  e  s  an-I 
(ioRS.  Krror, 
riu  percent. 


Weber     and      Infnped  waltr,  ua?-ln'd 
Lehuianu  ont     vessel-:      drier 

mined   dry   •;Mb>-tanee 
of  bloiiii 


Haldaneand     <."0    intmle<i.      Carniin 
Smith  titration 

Kidtniann  +  Infu-iinu  uf  salt  nnj, 
and  ht'Miatiirrit  be 
fore  iintl  after 


1  3i)-\  in        1  L'l     s.sid: 
!  n.rj  1  13     1  i2.'j        g,2 


<  '  >  iniMhnd.    'I'nrai  u.n      ii  ui.nn  i, 
wdn  earniiQ  sid'itinn       12  iiu'ii 


Cf  I  niiMliud.   Titratinii        •.'  nien 
\\u\i  larnnn   soliitiou      4  uniiK'n 


I  Intn-ii'p  Mill;  lib, 
d«MernMnai;itii«^,  ■'.  (  > ' 
inhalation  uitti  khii 
biistiun 


3.3(>.27 


3.7-8.31 
2.5-6.ti![ 


1  -.ni  i*;.5      1,19     4.t;iM>.o:> 

i/--'o-l/iii.o       1/18     r>.o--'-t;.nj     r.  ';  error 


K  a  h;  Ml '  r-  r     lleiii  int'  n^eihud. 
and    W;ild 
uiaiin 


Fries BeiirinK  iiietlntd.. 


1/17.5-1,11      i;l2.t> 


•  Arch.  f.  ptiy>i(d,.  is^n,  xxil.  5t8:  1S81,  xxlv.  525. 

t  Arth.  t.  e.vpir.  Tatli.  ii.   I'luirinakol..  vjcti.  liv,  3j«. 
:  Tr.  I'ath.  Nnc.  I  nndon.  Im«'.  li,  311. 

•  iT.  per  IHt  Krnins  of  body  ueight. 


O  t  !i  e  r  praeti 
(ally  normal 
patirnts  gave 
similar  vain*"- 


f 


17 

NdKMAI.    AND     I'AT  1 1  (  ll.(  ICKAL    \AK  1 ATK  i.NS     IN     lil.lidK    AND    I'LASMA 
VOLUMK    IN    MAX 

Results  {  Xonual) 

At  k'a^t  14i)  ik'lcrniiiiatinn^  *or  ]ila>nia  voluiiK-  lia\c  l)(.'cn  made 
(HI  iiKirc  than  Ino  iiuli\  iiiiiaN.  In  the  rarlicr  wurk.  licniatocrit  -tudies 
were  not  made,  mi  that  the  \  akies  for  t(jla,l  hluud  volume  are  con- 
siderahly  fewer. 

Xoniuil  / '(i/;(i\s-.-  -1  he  resuUs  here  reported  are  fur  normal  men. 
heinj,"-  obtained  from  jiatients  attendin<;  the  outpatient  dejiartment  of 
the  t;enito-nrinarv  elinie  for  some  minor  local  condition,  such  as 
chronic  urethritis,  chronic  prostatitis  or  verumontanitis,  etc.  The  as^'e, 
weitiht.  height  anil  hlood  ]iresstire,  as  well  as  the  blood  values,  will 
be  seen  in  the  accompanvinsj  tables  (  .^  ;ui<l  (>). 


T.ABLF.    ? — Plasma    Values    in    Twenty-Four    Subjects 


So, 

X:imc 

Diiti' 

Ad.' 

WeiRlit, 

.■*.8 

Ho 
Fl. 

5 

Kiit. 

la. 
3 

H.  v. 

Sys- 
tolic 

125 

Vchiiiie, 
c  c. 

Co. 
|.ir 
Kf. 

Frao- 
lion 
Ho.ly 

W.)fc.|it 

Per 

Cent 

Bo.iy 

Wi'ignt 

1 

F.  .1.  ... 

I  2 

31) 

3,100 

45 

1,21.(1 

4.0 

i; 

K.  M.    . 

1  <; 

22 

6<.l.5 

5 

10 

2.T75 

47 

1,20.7 

4.S 

3 

G.  1'. 

1,7 

40 

511.1 

5 

6 

115 

3.050 

53 

1  1S.3 

5.4 

4 

.M 

1  7 

39 

.-1.8 

5 

11 

2.70O 

52 

1  18,11 

5,3 

5 

P 

i.y 

34 

73.5 

5 

3 

138 

3.050 

42 

1,23 

4,3 

6 

V 

1,9 

23 

.\S.fi 

5 

: 

;io 

3,050 

52 

1  is.r, 

5,3 

- 

c 

2  2 
2/4 

.53.4 
53 

2.iH5 
3.025 

55 

1  17.« 
1,  17 

5.6 

5.8 

s 

F 

2  '2 
2/1 

67 

67 

3!i>50 

43 
15 

1  22 
1  21.G 

4.5 

4.6 

9 

S 

1,29 

2,'. 

IIS, 4 

h 

r, 

3.100 

45 

1  21.(1 

46 

10 

If   S.  .. 

I-',  28 

3.i 

.>.!) 

-, 

5 

:o 

2.1175 

.'/> 

1,20 

5 

11 

H,  .. 

12  2S 

51 

-.1 

5 

1. 

122 

3,275 

4,'p 

1  21,0 

4  6 

12 

J.  J.... 

12,28 

22 

57.5 

5 

... 

2,HiO 

41) 

1  i;i,s 

5 

13 

.T.  .S.  ... 

12  28 

4''. 

liS.lj 

5 

3 

142 

3,075 

48 

1  20.4 

4.9 

\{ 

J.  C... 

I2,2i> 

43 

Tl 

5 

1! 

130 

3,325 

4S 

1,  L'0.4 

4.D 

15 

u.o. .. 

12  2« 

."u 

71 

5 

in 

3,l,-.0 

45 

1  21.11 

4.6 

Ifi 

I!.  S.  ... 

12,:(1 

32 

1)5, 3 

5 

6 

145 

3,100 

47 

1  2u,7 

4.8 

i: 

(i.  11.  .. 

12  31 

.3(i 

(;2.5 

.-, 

10 

120 

3,100 

M 

1  20 

5 

IS 

G 

12 

34 

60.1 

4 

8 

130 

3,300 

48 

1  20.4 

4.9 

I'.i 

F.  I,.  . . 

1,2 

32 

--CO 

5 

5 

105 

2,51.10 

41) 

1  i;).s 

5 

:o 

F.  .s.  ... 

12,30 

49 

6(1.8 

fi 

130 

3.200 

4.S 

1  2(1.1 

4.9 

21 

K..I.  ... 

1,5 

70.5 

G 

2 

S.7."K) 

53 

1  1S.3 

5.4 

"2 

J.  M.S. 

3,11 
3,12 

52.3 
62.3 

2.(175 
2,1175 

51 

61 

I   10 

1, 1'.' 

5.2 

5.2 

L'3 

D 

]  22 

70.* 

5 

11 

130 

3,375 

48 

1,20.4 

4.9 

24 

s 

!,-I2 

5r  i 

5 

- 

2,s;3 

ia 

:,2o 

5 

f 


SagSSSi!iJ5J;z"S3SX-2    3i; 


i) 


S    8    8    i-    l-'T    3    !^    51    S    'T    "    S    I    §K    S    g    ¥i 

';       ^      y      I-      i-^_      &      Ti^      K       ©      X      I-      ■^l      c       -.1-      '-'=      «      I- 


'^       —      irt      ^^      >.*  o      lO 


'C       >n      o 


h   !' 


-c'      -c      -ii     oi      X  s     ■?!      -t      ci      t2      —      —     'r     '2      "C  ^-     !r 

is         I?.         in         ^         '"   —         O         I.*         O         O         -S         *-.         »■-         "--         •—  >..         '— 


III       c> 


A       U>        I- 


•^         M         OC 


—       c;  o      <xi      X      ^ 


i    5 


^-:  5   .^.?  3 


i-  <'.    p    ^r:    r^    .-3    c  |-    ;-    5    §    g    ;-;    it    ^    5    ;:  ,=2    =    5 

■—  C        <  -        ■'*        "T '        CI        ■^  -t        ^       X        C:        CI.       '-\        X        jC        ?^_^       ' "  -"^       '^       '  ~ 


r;  :3       CO      «      c-3      «■!       C-:  :■! 


ci      M      M       »      CJ      z-i      z-i      'jiei      CO      oi      n 


1    i: 


:  ■;       JD      I-      ts      i-~       —  » 


X      o      re  >~      ^_      X       zi      '-      '-*      >-•:      -t>      CO      itt  oo      •-;      x      i--_ 


1-  •»•      V     ^      -»•      f      -*      irt"      o      •- 


a-      o      —      r:      I-       M  or;?' 

Ct         »)         C.         Ci         Cl         -^  ^         CO         5' 


-^        I'.        X        T.        = 


19 

I'la.uud  I'dhii-s.  l''nrty-ciL;lU  ilftcTinitiation-  witc  iikuIo  on  furlv- 
t\v(i  ]i:itii-m-.  Tlio  larL;i--t  {^.77r  c.c.  i  and  snialk---t  ( J,45U  ca.  , 
\cihnnc-.  wcru  riu-nnnti'icd  in  llir  hca'.ioi  ( S5  ki,'.  )  ami  lii,'lite>t  (47.4 
ki,'.  >  palicnt>  (  Xcj-.  2(>  and  M>  rc--|iL'cti\  els  l .  TIk'  mean  weight  was 
(i\.2  kt;.  and  tlu-  mean  Vdlumc  3,123  (.'.o.  ;  tlie  a\ iTa,i,'(.'  weight,  fxv.i  ki,'. 
and  till.'  a\(.Tai;e  \iilunic  .i,05i)  c.c.  'I'lic  i^la^ma  \aried  frum  4_'  to  rh 
ex.  \K-v  kilo^rani.  wliilc  the  frartii.n  ut  l)(idy  \veit,dn  \aricd  t'rdin  1  2.i 
III  1  17.  the  axirat^e  lieini,'-  1  1'*.4.  (  l-'fum  ihi^  it  a])]iear:-  ll'.:il  ;i  normal 
man  of  140  ]Miunii-  ha--  .i  liter--  of  pla-m.'t.  or  ,^l)  e.e.  per  kt,'.  )  'I'he 
i-on-.lanev  in  the  r'kition  ot'  i)l;i>ma  to  body  \veif,dil  in  health  i-  slrikiiii;, 
there  hein^  no  i^re.il  extreme.-;. 

IUih',1  I'tdiirs.  The  niimher  ot'  determination-  of  tot.d  blood 
\alue>  li:i<  not  heeii  -o  lafi^'e.  1  w  enl  \-i  me  determination^  im  (.ii^hteen 
norm.al  iiii|i\  idn.d-  were  made,  the  whole  hlond  \ahle-  lieint^  caleu- 
lated  friiin  the  pla-nia  \iihime  .-md  hematoerit  I'indini,'-.  The  plasma 
eonbtitnie-  on  the  a\  eraije  ."' i.' '  ]ier  eeiit.  of  the  total  hlood,  the  i  \t rentes 
Ileitis,'  .^1  Jier  cent.  ;md  d-'.ii  per  eenl.  d'he  lars^e-t  and  >malle-t  Ndhtnie 
('i/i7,^  e.e.  .and  4._'iWl  e.e.  )  were  ohtained  in  the  two  patient-  mentioned 
.alio\e    a-    h:i\  ins;    the    l,ir^e-t    and    -malle-t    ]ila-m,a    \olnme-.       Ihe-e 


patient-    -iiowed    /S..-    .am 


])er    kilo,i,'ratn.    re-peeti\ely.        The 


aver.iL;e  Moiid  \ohnne  wa-  .^..i.-d  e c  or  appro.\inialely  ^^.^  e.e.  jier  kilo- 
t;ram.  <  hi  a  ,t^ra\  inietric  ha-i-,  die  iilood  e<iii-tituted  SS  per  eent..  or 
1  11.4  of  the  lioiK  weitjht.  The  variations  in  he.iltli  were  not  f^'real  — 
from   1    1.1  to   1    111..-  of  the  hod\   \\ei>,dit. 

The  eon-t.iney  of  tlie-e  \alue>  i-  in  .-irikint;  iontra<t  to  those  nf 
Haldane  and  .'^mith  '  .and  of  (  lerum.-"  who  found  the  hlood  l)ody-m,a--> 
rel.ition-hip  e\ieedini;ly  xaria'ije.  llie  re-nlt-  here  reported  -upport 
the  litiitre-  of  \\  eleker  and  I'.i-ehol'f.  \  ierordt.  Kotlmami,  I'.ehrint,', 
l-'iies,  and  Kamiiierer  .iiid  Waldmann. 

Cliii'h\}l  Studies   {  Palhohuiicid) 

Si\t\-li\e  jialieiit-  were  studied,  the  determination-  mimherinj,' 
ei^hty'eii;lit. 

I'or  purpo-e-  of  di-eussion  the  cases  are  .^roitjied  aeeordiiis;  to 
elinieal  eondition-.  It  i-  to  he  le^retted  th.it  the  mttuher  of  ea-es  in 
eaeli  ^roup  i-  nui  lart^er.  dhi-  wa-  im]io-silile.  since  the  dntt;  is  ot 
( lernian  origin  and  ile-|iite  repeated  ellort-  it  wa-  imiio--ihle  to 
secure  .a  fttrther  supply.  "  d'he  ,-co]ie  of  the  work  ha.-  been  limited  by 
the  -mall  .■inionnt  ot   d\e  available. 


,^n    It  i-  iinil.;iMf  that  many  ilve;  will  an-«or  the  purpn-e  ciinall;,   ur!I      Stmlies 
al'iii).;  ihi-c  Hiu-  arr  ii"W  m  priii^ress. 


i  l-J         «  M         C" 


i^   ;i^ 


5       "^      :,^ 


—  X 


«  W         -M         .- 


^i2 


58  ill; 


£  ?     «  3     3  i 


;:  «      I.-  ^  eo 


1-  n      I- "      '"30      Ti  > 


Sr:    rfS3     SSi    SSS    S3    S3    fiS    SS     Si5 


i='i   21--=   ^3   ?TS':^    S^   sr: 

M  ?l        OSM-r       elffl        P?  «  ^J        MCI        M?) 


M  51 


IS 

3J  S 

0-2 

1 

cc 

ore 

C-;  -1 

1.1 

k.-? 

TI 

r^ifi 

lA 

S5 

sm 

3 

K 

'~  — 

;^S 

1 

.•0 

»  :    f?  :  :    -  :    S 


§;  ^ 


s;  a;;  ?i 


i  •   1 


13  ;    8 


—         S!;- 


«  •-      £1 


• 


lA  •—  ^3         I- 


SS 


• 


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I      • 


k      • 


t      • 


r      • 


21 

I'rcmaiu-y.--^  )1,.crv;ition.  l,.ivc  Uecn  nuulc  bciurc  an.l  aia-r  deliv- 
ery in  ckv.n' ca.u.-  (Tabic  7).  In  tho  latter  months  ..1  pregnancy,  the 
Mood  nla^^  in  pro,>.,rti.m  t(.  the  body  \veii,dit  is  .letinitely  increased. 
Whereas  norniallv.  bln,,d  constitutes  S,8  per  cent.,  in  twelve  pregnant 
Nvonien  prior  to  l;ibor  the  blood  averaged  9.50  per  cent.,  which  corre- 
.,H,nd,  to  the  highe.t  limits  of  normal  v.alne  In  tour  in.tance^,  the 
1,1, ,„d  valuer  rose  con>ider,ably  above  normal  linntv  The  plaMua  vol- 
ume^ were  c.rre.^pondingly  increased,  averaging  .-S.4  c.c.  per  kilogram, 
in^tea.l  of  .^H  c.c.  Determinations  made  .i  week  ti;  ten  days  .after 
P.lH.r  d.owed  tiiat  a  great  decrease  in  the  blood  ma^s  liad  ,.ccurred 
xvhich  .unld  n,.t  be  accomned  for  bv  lo,.  of  weight  (child,  placema 
,,„,,  ;„„„„„„.  iluidi  or  kw,  of  blond  .at  ,.artnrit,on.  .\fler  labor,  the 
blood  and   plaMUa    lormed  "  per  cent,   and   4"  ,.er  cent,   of   the   body 

is-ht.    respectixclv.      The    average    lo^>    of    biocul,   .according   to   the 

ub-t^elrical    report   of    these   ea>es.    w.a.   only    .^(Hi   c.c,   wherca^   bloo.l 
xdlnnie  Mu.lie>  -houcd  an  average  lo-  of   l.bHi  e  c. 

l.;,,,,,!-  have  been  made,  but  uidmut  -ncces-.  to  lind  the  dye  in 
,hc  placenta,  i;  tiie  .nnnioiic  ihi.d  .and  in  the  .hild^  urine.  folkiwing 
,hc  admimMralion  nf  the  dve  mtrav  en.  ai-ly  to  the  mother  during  labor. 
Abnormal  ab-ori^no,,  of  ilu  .l\e  would  not  -ecm  lobe  the  explanation 
„f  the  high  blond  x..hic^  re.orded  m  pregnancy.  Ihi^  .  ipinmn  i-li-.^d 
„„  ,,,^.  ,-.,„   ,|,.„  ,„e  decrca-c  m  blond  ma~.  ,^  imt   fnund  imme.hately 


after  p.arturitinn.  fnr  ni  t 


\\..  ca^e-   (J  and  4  I   it  will  be  -ccn  that  deter- 


w  1 
w  i 


nnnatinn^  ma.lc  tbirlN  -ix  hnur-  in  one  c.a-e,  .ni.l  four  d.ays  .ilier 
deliverv  in  the  other,  dnrvsed  the  -ame  high  v.diu^  for  plaMua  .md 
l,lno,l.  '  Snb>ec|tiem  detcrminalion-.  ten  day^  alter  labor,  dmwed  m 
l,ntl,  ca^e.  the  marked  decrease  recorded  m  the  oihcr  c.a^^e.  ot  (he 
series.  ■ITc  consideration  of  blond  volume  in  relation  tn 'pregnancy 
11  innn  die  subiecl  ni  a  sejarate  cnninmnicalinu  m  cnliuburatiun 
th  I'r,  I.  U.  Miller,  with  wlmm  this  part  nf  the  unrk  was  earned 
,,ut  in  the  wards  nl    I'ml.  J.  Whnrid^c  WiIIkmiis 

n,ese  lindini^s  .nulirm  ihe  uidcsprci,!  bebcl  .inmng  nbstelriciau- 
that  pregnaiU  wnnun  s,.,„,!  lKinorrhaL;e  mri-nallv  uelb  fomp.ara- 
tivelv  verv  iarL;e  bb  edin.^s  m  eclnnpsia  ,are  uell  bnrne.  It  unuki 
.,,,,,e'.,r  th.U  N.unre  h.is  here  a  f.utnr  ..f  ^al'ety.  tlic  large  blood  vohune, 
saleL;u.ndinL;  .c.;a.nsl  the  effc,  ts  nf  hemorrhage  before,  duriiiK  or  after 
l..il„,r  Or  u  ni.o.  b.-  ih.ii  the  l.ua^er  blood  supply  is  necessary  for 
pinper  nnlrilion  nf  the  chiid 

Case  II  ".I-  .nnipb>,ited  by  secondary  lues  and  luphritis  It  doc-^ 
not  accord  with  die  oiher  caves  nf  the  sitics. 


t  • 


22 


I-  iihh-ial'uni.  Two  ca^c^  (1  and  J.  'i'aMc  S)  are  iiK-link'tl:  'I'he 
tir-t  i--  in  a  Wdniaii  wim  hail  lo-t  1_'  to  13  ki;.  llir(iu;,'li  \<iliintary  >lar\a- 
linn.  Tin-  ]'la-nia  \cilniiu'  i~  ab-nluU'h  niirirja!.  and  ^in^■l.'  reel  ccll^  were 
4,1  K  i(i.(  i(  i(  I.  Iiir  lilocid  vcilunie  wa-,  in  all  proliability,  nnl  much  below 
nurnial.  'I'he  ^eecind  ]iatient.  \ery  lall  an.d  lliin,  aK(  i  -lidwed  strictly 
normal  \  allies. 

Obesity.  Six  ea-e-  i  Xo-.  .\  4.  12.  _'(..  .^1  .md  M.  'I'al.le  Si  >l!owed 
in  e\er\'  m-lanee  a  ]ila-ma  \ulume  decidedly  liejuw  thai  o'  ib.e  a\eraL;e 
normal.  1  he  average  wa-  .^7 .\  e.e.  I'er  ki;..  or  .xS  per  eenl.  ol  body 
weight,  \\hieh  i-  le--  lli.in  ihree-l'ourlh-  of  llu'  nnrmal  \alne.  In  llic, 
line  ea-e  i  .■iJ  i  in  wbieli  a  hent:itoerit  reailini,'  wa-  oblaineii,  .~  1  e.e.  jier 
kiloi;ram  oi  blnMii  \s,i-  found.  'liii>  jialient  had  onl\  .i-  niiuli  blooil 
|ier  kiloi,'rani  a~  the  unrm.d  indixidiial  has  ]ila-ma  jier  ki!oi,'ram.  Case 
.^  i~  of  eNlreme  inlere-t.  ina-nuuli  a--  the  |ila~ma  lovmed  le--  than  ,>  |ier 
eenl,  of  ihe  limh'  \\eii;lu.  I'be-e  tindinu:-  are  in  barmone  wilh  tbo-e 
of   I  hildane  and  .^niilb, 

l-iiuhuitiiiti  ,tnil  .li:rii:'ii.  I'en  eases  (  Xos.  5  to  14.  inelu-i\e, 
1  able  Si  exhibiiinii  I'Uiaeia  'on.  in  i  i  inibin,:lion  with  nindrr.-iie  or 
~e\ere  -eeondary  anemi;'.,  w  e  •-tudied.  In  tbrei'  of  tlie-e.  in.di^nant 
i,eo|ila-m-  were  pre-enl.  In  -i.\.  ibe  ]ila-ma  Miluine  \\a~  bii.;hi.r  lli.aii 
the  ;i\erai;e  normal,  .and  if.  tline.  ;tl  morin.dK  hit^h.  ihe  .i\er.aL;e  in 
eiv;hl  ea-e-  \\.a-  r' '  e  e.  per  ■-ili.;;ram.  wbieli  Midiiale<  a  -i  fon-  plrtin  ir.i. 
In  four.  llu  total  blou.l  \oinine  wa-  -ludiid  and  three  :'.i\e  low  \alue>. 
It   i-  e\iiUiit.   llureiore.  th.at   in   -iieh   eondition-   In--,  nf   pl.i-ma   doe< 

tioi   ;^ii  h.ind   in  b.iiid   with   In--   of   \\eiL;bl   and   deerea-e  ol    rid   bl 1 

cell-.  I  iifortmi.iIeK ,  In  in.ili  niit  -ludie-  were  not  m.ide  in  the  ear- 
eiiiom.i  ea-e-.  With  the  dii^ler  ■.!  .memi.i  mdii  aled  in  the  table,  it  i- 
evidetil.  however,  lb, it  the  toi.il  lilmid  Milnnii-  nin-t  ha\e  bn  n  appro.xi- 
iiiatelv  ni  inn.d 

Siliei   the  .i\eraj;e  bl 1  \.ilue  w.i-  7S  e.e    i  1     1  .i  J  ol   biid\    weiijht  ), 

instead  ot  S.^  e.e.  ]ier  k^'.,  it  beeome-  apiiamit  tli.at  the  anemia  is 
fairly  aeeurately  itidieated  by  the  tiloml  eount  In  I  ,i-i  -  S  and  11, 
tlierc  is  a  dcereasc  in  the  vdIuiik',  as  well  ,i-  in  the  cell  eoiiieiii  of 
the  bldcid. 

/'(■i»iii-|(i|(.\-  .hltliiia  •  'nl\  three  e.i-e-  i  Xo-  1.-.  bi  atiil  17,  'I'anle 
7)  were  studied,  .\o.  ]?  -hi. wed  ,in  i  \tieinely  liiL;li  pl,i-m,i  Milimn'  of 
72  C.e.  per  kj;..  the  biuhe^t  eiieolinlireu  olll-ide  of  preun.iiky.  Ihe 
lilooij  voluiiM'  wa>  normal,  but  sli;;hlly  lulnw  the  .i\er.iue  In  the  other 
twi),  ])la-in;i  values  were  normal,  and  the  intal  Milume  i  ..n-ider,ililv 
(Uvreased. 

\\  illi  -o  y;re.it  :iii  iiierea-e  in  ]il;i-m,-;  \olumi  i.i  *  .i  e  I,-.  It  was 
tbiiiiLiht  th.at  the  whole  blood  m;i--  mii^ht  be  kiiu" f  th.in  nnrm.d  .ind  be 
briiu;;lit    into   e.iit-.d    lel.itinn-lnp   with    die    inl,irL;id    lu.irt    -muelime- 


23 


r 


■-ccn  in  lurnicious  aiR-mia.  'I'la-  two  Mibscqucm  ca^^•~  -hnwcd  kiw 
M,„„l  vahK'.  and  no  caniiac  enlargement.  FurMicr  data  in  this  con- 
nect inn  are  necessarv. 

y>„/v.-v//,.-,»u;.--Mnlv  two  ca^e^  ,  Xo~.  IS  anal  1".  Tal.le  S,  with 
iH-h  hl.Hul  counts  were  >tu.!ied.  Patient  IS,  thron,t;hout  several  weeks 
-tav  ii,  the  uar.P.  rrc-ented  a  ^er^i-tent!y  hii;h  red  cell  cotint  (  S,(X)0.- 
(KHM.  Two  deteniiination-.  a  week  interv  enin-.  yieldo  identical 
results,  that  i~.  hoth  iila-ina  and  M-.od  volumes  were  decide<lly  smaller 
,1,:,,,  normal  Tlii^  valient  cannot,  therefore,  he  con-idered  plethoric, 
-ince  he  has  ,,nlv  7.^  c  c.  of  Mood  per  k-.,  instead  of  the  normal  S.s  c.c. 
per  k};.  The  total  niimhcr  -f  cells  and  the  ahsohite  hemo-lolan  were 
proh.ahlv  ahoiil  norm.d.  The  apparent  j.letliora  was  catised  hv  ihe  low 
pla-ni.a  "content  of  llie  hhod.  .V'  c.c.  instead  of  .-( i  cc    per  k-. 

l'.,n,,n    1"   showed   a    red   hi 1   cell    connt   of    .^. ,( K  li )( K »,   a   count 

di.'hllv   ahove   nornial,       !T,i~    i-   an    in~laiice   of    iriie   plclhor.i.       1  he 
phM.i.a  Nohime  was  also  coiisidciahly  ahove  the  avcia,i;e  normal,  hem- 

o()  in-tcad  of   .-tl  cc.  per  kiloMnmi.       The  hi 1  pre--nre  was   l.y  W, 

vshile     the    hi 1     was     11.^    e.c.     l^cr    kilo-ram.     mle.ad     of     85    C.C. 

per  kilogram. 

•Idiesc  cases  strikinulv  .lenioiivtrate  the  necessity  of  total  xaliie  lor 
ihe  proper  interpretation  of  the  louiine  methods  of  -in/iym..'  the  hlood. 

■Jiiree  other  c.a-c-  showed  counts  -..mewh.!  .ihove  the  normal, 
h,  two  of  ihc-c.  ihc  pla-ma  ■.■Tniie  v,a~  low  ;.nd  the  hiood  xolume 
conseiltleiillx   ni  't  inciea~ed, 

/)„//>,-/c.v.  'If  die  f..iir  patients  v.h.-e  cases  were  -ludied  (  -\'os. 
M  to  J.v  nichisixe.  1  ahlc  Si,  three  were  moderately  thin  nun  and  one 
,„  ohe~e  woman.  nie  three  men  lu'wed  .a  sn^ar  content  m  ihe  hlood 
l,elwecn  D  IS  per  cnt  and  <l,4.s  per  cent,,  and  .all  -la.wcd  plasma  and 
hlood  \olninc-  Ih.n  wei-c'  Mnclh.  uiih.ir.  the  himt-  oi  norm.d.  Ihe 
ohese  patienl  >  -N...  -'-' '  showed  hlno.i  volmne  dccidedlv  l.elow  normal. 
M,  tlMl  llie  ohesitv  exerted  a  -n  ater  nitliunce  on  ihe  hlouddiody-mass 
relationship  than  did  the  i;l\co~nvi;.  hro,,,  tiu-e  l-iir  ,ases  it  appears 
that  an  incre,a-c'  m  the  hi 1  \olnnu  d..e~  not  ie~nh  i  torn  or  accom- 
pany hyperL;lycemi,i. 

\lxoa\rd\a\  l>L<,itiu'inuy.  Nnu  (Ti-ma  delcnmnalion  -  were  made 
on  .iwen  eases  ,  No..  JT  to  Mk  nuhi-ue.  lahle  S,  of  ni>oeard,al 
insumciencv.  Nepl'nti-  \^.'-  •'''-"'•  '"■  l''T^cd  a  \ .  rv  minor  role  m 
this  s^.rics,'  >e\eral  of  thc-e  patients  had  marked  edeiii.!,  and  thf  aver- 
age \..llimc,  17  c-  per  kiloi^ram,  was  slighllv  low,  m,  th.at,  in  general, 
edema  is  not  associated  will,  .m  increase  in  plasma  eorrespondln^;  to 
the  increase  in  weight.  Hi^ih  values  may  occur,  as  is  seen  in  I'atient 
Mt  Ihe  lowest  plasma  value  (Case  27)  is  associated  with  .i  liiyh 
r.d  lilood  count. 


Xo.      Niiiiie         Uato       lli.-iury      Agt 
So. 


TABLI".   S.— Clinical    ( Pathological  i- 


I'lilfllOSiS 


Red 

liloD.l        Hfh. 
Ci'lls        S:lhli. 


Wclglit 


A  tual      I!c'-t 


1 

A.  K. 

1,15 

33381 

32 

1  .  .1 

1  5 

33514 

ii 

;i 

li.  -M 

1   1.'. 

33.-« 

a 

4 

1      N. 

1  li 

:a-io<i 

,w 

5 

R  IJ. 

10 

S346T 

66 

■■ 

.1    II    ( 

1    ]■-' 

:b.".".:i 

;: 

; 

.1.  II 

1  (. 

3:i4Tl 

M 

8 

A.  K. 

3  la 

3:!eis 

31 

V 

,1.  X. 

I  15 

33j8« 

48 

10 

II.   W. 

1  'J 

'Jj 

U 

.Is 

3304U 

•» 

I-J 

H,  A. 

1  8 

,135J-J 

:a 

13 

1      \1 

1-' 

oiN."  > 

U 

1'.  .S. 

■J  iJ 

;!37H 

31 

i;, 

1'.  .1.  U. 

33433 

4-' 

w 

T.  A. 

33770 

33 

17 

W.  .M. 

•■.  11.  1. 

tu 

lu 

F.  O. 

1  3 

3;i.-.2ii 

2j 

■Jl) 

(i.  V.  H. 

3  18 

■xviia 

23 

•Jl 

1-:  X.  V. 

3  11 

337S7 

<» 

•£! 

.M.  H  .1. 

1  Jl 

33487 

37 

•-•3 

1     w 

:   12 

33617 

■::i 

54 

11.  .s. 

1   12 

33.-.71 

41 

•a 

<).  O.  M. 

2  17 

3373.-. 

IX) 

26 

W   ,I.R, 

1  l.i 

33M4 

70 

27 

.I.S. 

1  u 

G.  No.  1«72» 

48 

28 

w. 

123 

29 

,1.  .S.  SI. 

1  « 

33521 

59 

3i> 

.1.  F. 

I    12 
I  22 

:av!i 

I  ' 

31 

K.  W.  S. 

54 

33i;:- 

t'liriinic   panorcatilis.     Malnutri-        4.022,000       82 

linll.       VisrProptOSiS 
.\..ldiiil.      l';iill    ia  siilo S.UlO.nOO       100 

.Syphilis.      Olii-sitj-    4.200.000        84 

i:>hi'sity.       Myncarrtial      Insufflcl-        ,i,noo,000       SO 

I'Dty.  hypt'rti'n.sion 
CnriiQonui  sioiiinc'li  2.i:oo.COO       4."i 

Ailiylia    KMslriiii:    malnutrition.        4.ii0'-i.o00       80 

.Vrti'ridsftrrogi!* 
t'ul'i'innlMa  prostali".     Mi-tnstascs         2. 120.000        4.'j 

.siviiM.lnry     ani-inia.        Ulnrrlii'a.        S.iKxi.ooO       01 

INyrliosis.     .Miyraiuo 
Cariinuiim  stolii:'.i'h    3.600.000        «.» 

llnlantiilMini     cdI:.        .Si'con.l.iry        1.072.000       20 

anfiilJa 
Si'couilary    ani'lnia.      Leg    uleiTs         L.'OO.OrtO        31 

Anaildlly.      Malnvitriluin.      Sec-        4.ri<i(),ooo       70 

mitlary    aniMiiia 
liiiipili'ual      iilfiT.  .Si'comlary    .    3,500.000       7.'i 

ani'iDJa 
Aiuti'    ni'pliritl.*.     Syphilis.     .Sec-        3.M0.«K)       er, 

miliary  anemia 
rernicioiis  anemia  l.l'J2.0oo       28 

l'ernieioii.s   anemia   1.500.000        25 

Peuieious  anemia.    Aplastic  type  1  17. 

I,:iiio.i«K);       22 

1  28. 
800.000  15 

reritoneal      ailliesinns.         I'uly-        S.OOO.OOO      100 
eythemiu 

-Mitral   In-suftlclency.     Left   henil-        S.iiOu.OOO      101 

plegiu 
rilabeies   mellitus.        Pulmonary        .'..400,000       !<8 

lnberelllii«i|>.      t'olim 

Dialieifn    mellitu!!.        Pulmonary        1.700.000       82 

tnliert'iiln<«iit.       Arterioseleriipis 

.Viirtie  Insulllriency 
Ulabeien   mellitus.     Oboslly...  .S5 

niabeli's  mellitus   5„"<m).ih)0       8:i 

Myoeanliul    insiimciency.        Pul-        5.2UO.OOt>      lOO 

mnnary  tuberculosis 
Ar,.ri  .r.ler,..!-       Myocardial    In-         4.700.000        94 

-UlluH'IU  > 

Myocarilial  ln»iifllclency  .-.,000.000       84 

Syphllii".        Aortic     Insuflielency.        ii.jOO.OOO      107 

niyoeanliril  insutflejency 
Myoearillal  Insullleiency  » 

ArterloMlerosls.        Angina     pec.        5,000.000       3U 

K.rln      Myoearillal  iuHolBileney 
syplillH    ot    lorla.       Aortic   In-        

*iitlleieney 

Pulmonary  ttibrrciilotit.  Afrrlo-        5,000,000       79 
•cirruili.    Chronic  Mphrltli 


36.8 

48 

70.5 

05.4 

100 

107.7 

i:u 

43.0 
43.9 
55.9 


50 
44.5 

:,9.5 

13 
('.8.2 
r.1.1 
53  .li 


BO.l 

72 

:2.5 

53 

58.2 

70 

80.9 

SO 

51.1 

67 

7">.2 

8i 

a:. 3 

73.4 

89.5 

H8,8 

TJ.2 

88.5 

112 

00.4 

59.1 

00.2 

r 


r 


— Studiks 

UN     Bloou     V'dLCMI. 

Edema 

l!lo.„l 
I'rtssure 

Cardlnc 

l:iilart;e- 

liieul 

■ 

I'Uifina 
e.e. 

r,e. 

I'er 

Hema- 1 

toerit 

I'er 

Cent. 

riasma 

lilooj 
Vol 
uine 

C.C. 

IHT 

Per 
lent, 
li..<ly 
Weight 

Frnc- 

lu.n 

lioily 

Weiglit 

K.niarks 

Nout 

m>  i«i 

Noil.' 

LS'iO 

50 

None 

l-JO    M) 

None 

o,7r>t> 

53 

60 

6,250 

89 

U.3 

1  10.!) 

6  feet  '■)  inelii'-^  in 
hi'iglit 

None 

1-J(i    TO 

None 

e.T-.'.') 

28.6 

Slight 

210  110 

Mo.liTiite 

i,:M 

45.S 

None 

100,   60 

None 

2,j7J 

66 

70 

3,425 

88 

1'.2 

IIO.S 

Xune 

IM  100 

Non.' 

2,375 

45 

Kight  leg 

130  c:, 

None 

3,l.'iO 

64 

77.2 

4,075 

H 

6.8 

1,11.4 

Nune 

100/  6j 

None 

■:,17J 

4'J 

65.3 

3,325 

76 

8 

1/12,5 

None 

no   6j 

Sjiiiht 

3.725 

0« 

ModiTiite 

lii.V  4,-. 

Mlflit 

3.42:. 

60 

80.6 

4.025 

70 

7.3 

1,13.6 

None 

None 

2.'.iOO 

57 

78.8 

3.675 

72 

7.5 

1  13.2 

None 

i;o,  IK) 

MlKht 

2.120 

47.6 

1.7.3 

3.150 

71 

7,1 

1  13.5 

Nunc 

1(10    or, 

Slifllt 

3.400 

57 

70.6 

4., 'too 

SS 

U.2 

1,10.8 

Ni,llf 

]■'-■     70 

Mitllt 

3.225 

.-.1 

61.3 

5.025 

80 

8.4 

1,12 

Nn:,' 

ii>>    .•,:. 

None 

4,1)50 

72 

ao 

:,.:m 

81 

8.5 

1  11.7 

None 

l-JO,   70 

JSligllt 

3.450 

04 

$4 

4.250 

66 

0.0 

1,14.4 

Iniprove.l 

None 

None 

2.850 

53 

Ule.l 

.None 

lai   70 

None 

l.'.CS 

3'J 

53.2 

3.725 

73 

7.7 

1   13.5 

2.000 

3a 

53.2 

3.750 

73 

7.7 

1,13.5 

None 

I3j;  00 

Sllgllt 

4.125 

00.7 

52.5 

7.hK) 

113 

11.0 

1  8.4 

>Mne 

HO'  [10 

None 

2.175 

51.3 

57 

3..»00 

8U 

9.3 

1,10,7 

Bloo.l      gluec^e 
0.25.)). 3 

None 

11X1,   IH) 

SliKiil 

:;.275 

56 

62.1 

5.375 

92 

9.0 

1,10 

Neerop!»y 
Blr)Oil       glllcos" 

0.45-O.lS 

None 

IL'O     70 

None 

2.825 

35 

BUto.l      gl)ico?»e 

0,1"' 

None 

l-.'O    w 

None 

2.775 

51 

11  loo.  1      glucose 
0.4^1.34 

None 

120    70 

None 

2.825 

35 

None 

120    SO 

N.,no 

2.775 

51 

.Morke.l 

!«)   rni 

M.i.l.  rale 

3.!W 

.'« 

Murke.l 

120    HI 

Mark.-.l 

4.375 

M 

51.3 

s.o:.« 

Might 

.Marke.l 

3.900 

.03 

M(.ileriite 

170  120 

Moilerate 

3.HI0 

42.5 

.M.i.lenite 

130 '  90 

Mirkeil 

3.II.',-. 
3.170 

40 
43 

45.6 

c.uoo 

Mn.leratc 

150  115 

Markeil 

3.975 

43 

Sllghl 

130'  m 

115,'   ? 

Slight 

3,3sn 

2.8U 

6fi 
48 

Slight 

100/  w 

Blight 

S,300 

36,7 

9.0  1,10.3         Necropsy 


0.1  1  u 

Nerrr.psy 

NVrropsy 

Weight    131)  lb(, 

la  1903 


TAI'.LL'.     t<.— Cl.lNIl -M-      (  rATHOl-OiaCAL)  — 


Nil. 

Niilili' 

Iniii- 

Hi^liiry 
Nil. 

Age 

32 

I.,  .1. 

33777 

47 

S3 

i:.  K. 

1  20 
3.  IS 

33757 

36 

2. 

i:.  (1. 

2  '21 

33697 

47 

X, 

(1. 1.. 

1  20 

33310 

63 

sa 

R.  A. 

2  17 

33643 

45 

37 

F.  W. 

2  17 

S3722 

47 

M 

M.  1  . 

1  23 

C.  U.  I. 

39 

.1.  K.  A. 

2  12 
2,18 

2  2.-) 

30283 

4U 

t'l 

H,  (1  •■. 

1   It 

3fiOS2 

55 

41 

N    I'.  I'. 

3  18 

36551 

51 

*:' 

i:.  s.  II. 

2  12 

3(tt'J8 

71 

43 

M.  P. 

1  12 
2  3 

33510 

32 

41 

W.  I..  I. 

1  12 
2  3 

33424 

38 

4') 

T.  K. 

1   12 

33,V14 

■29 

4i: 

A.  T. 

1  3 

33472 

22 

47 

1    \V. 

1  7 

33479 

71 

48 

!■    k    > 

1   12 

33.572 

.11 

46 

F.  N 

1  20 

333'.iO 

40 

■ii) 

U. 

1  7 

33333 

43 

1 

K   •!■. 

1  14 

33545 

n 

62 

M. 

1  14 

:a»r,i 

18 

.-.3 

s    II. 

.1  o» 

3  U 

36426 

48 

Diagnosis 


Bed 

Blooil        IlKh. 

I'flls  S;lllli. 


Weight 


Ailuiil     Bi-t 


• 


HypiTtcnsiiin.  Chrnnip  nei)liritis. 

•  i-iii..;irttiritis  of  spiue 
SyiOniis.   ArUTiosi-lerosis.   Ilyppr- 

lensioii.     Cliriinif   lifpliri'is 


AitiTiosderusis.  Ctironit?  in'i'li- 
ritis.  IlyptTtension.  I'oly- 
tytlK'Uiia 


Syphilis.     Hypirtonsiuu   

Clironic  nephritis.  Hypertension. 

MvooEirdial  insuSicienoy 
Cliroiiii:  nipliritis.   Hypertension. 

I  i'ri'!ir:il   liemorriiage 
Uypern-ii?iiin    

Chronie  nephritis.  Hypertension. 
Arteriosclerosis.      Hematuria 


Arteriosclerosis        HypertenBion. 

KnlHrgeil  prostate 
Arterioselerusis.        Hypertension. 

(.'areinonia  of  blaililer 
Arteriosclerosis.    Uyperten^ion  .. 

Chronic  nephritis.   Hvperlension. 
Myucarilial  insoHlclency 


Chronic  nephritis 


(■lirnnic  nephritis  

Chronic  prostatitis   

Chronie  infi'itinm'  ^irtliriiis 

Cerelirnl    arierioseliTosis.     Brain 

tumor? 
Kniphy-ema.    Chronic  lironehitis 

s\iiiiili>.     .Vneurysm   of   Ihoraiie 
aiirla 


Chronic   iippeniliciti* 
Typhoiil  fever  


Carcinoma    bladder.     Secondary 
anemia 


5.111*1.0(10        90  79.4 

3„')0().000        05  62.3  05 

5.'.'00,00i)       105  72  80 

6.000,000        S3  (10.7  70 

3.000,000        W  65.D 

5,S0O,00O        92  X.H 

a.m.,  78.3 

4.oiHl.(iO(\        80  76.4 

p.  in., 

3,700,000        75  

75.9 

70.1 

3.800,0(10        72  OS. 4 

50.1 

4,4iK).lKN)         03  S7.3 

70.3 

4.000,000        82  80.9 

79.5 

4.20O.0OO        93  l!2.7  73 

4.300.000       10()  52.3  61 

4.st«l.()()0        75  72.7  73 

.-16.4 

,5,000,000        90  51.9 

4,2iiO.iKl0         92  (il.4 

ii3  0  .    . 

5,000,000        iiO  4*  6 

4,500,000        .■«  OO 

3,300,000        33  ,58 

.58.4 


Stuuii's 


ON    Bi-iion    \'n]X-\ii:—i  Continued) 


i 


I 


I 


Kdoma 

blood 
Pres-bure 

Cardiac 

Kularge- 

uient 

Plasma 
e.t. 

C,c. 

Per 
Kg. 

Bema- 

tocrit 

Prr 

(.ent. 

Plasma 

Blood 
Vol- 
ume 

C'.e, 
per 
Kg, 

Per 
Cent, 
Uudy 
Weight 

Fr,ic- 

tion 

Hody 

V.  eight 

Remarks 

Slight 

ls(i  100 

Moderate 

2.70O 

34 

66,7 

4,o:)0 

51 

5,3 

Me.7 

Ntine 

L'oo  i:*) 

Slight 

3.050 
3.150 

49 

51 

None 

■JM  loO 

Slight 

3,050 

42 

56.1 

5,475 

70 

8 

1,12.5 

Wood  glucose 
0.12 

4S 

01 

5,675 

78 

8,2 

1  12 

None 

ls5  105 

Slight 

3.025 

50 

Slight 

■IV)  130 

Slight 

3,175 

4ti 

63 

4,913 

74 

7.8 

1,12,7 

Blood  gliicose 
0.14.    Wed 

None 

I'J.j,  130 

Slight 

2,950 

52 

54,3 

5.425 

90 

10 

1.10 

None 

180/  ? 

Slight 

1.S2') 

43 

1 

None 

:2r.  11(1 

Moderiue 

4,0,50 
3.875 

.59 
51 

d 

0,150 

81 

s,s 

1/11.9 

SO*J  e  e.  blood 
lenioved 

e35,'155 

3.425 

45 

63 

5.125 

At 

8.4 

1,13.1 

220, 125 

4.150 

55 

75 

5,500 

72 

7.0 

1,13,1 

None 

175  no 

Slight 

3.500 

,50 

60.S 

5,750 

81 

8.5 

1   11,7 

None 

i;'5,  no 

Slight 

4.325 

44 

60,4 

6,525 

65 

O.S 

1,14.7 

Died 

None 

210'   'A) 

Moderate 

3.150 

53 

Con=i'ler- 

ISO  100 

Marked 

3.S75 

44 

64.1 

li,025 

09 

7.2 

1  13.9 

Slight 

115    75 

Slight 

4.047 

53 

Moderate 

i."o  so 

Slight 

3.172 
3.0<i4 

39 
3.?,  4 

None 

IIX)'  S". 

None 

2.02.5 

40 

None 

140;  90 

Slight 

2.420 

45 

None 

IW  S5 

None 

3,450 

47.0 

63,7 

5.425 

75 

7.8 

1/12.8 

None 

v:o'  ' 

Slight 

2,825 

,56.4 

None 

no  70 

None 

2.4.'ifl 

45 

None 

120'  70 

Slight 

3,025 
3,175 

49 
60 

60 

4,900 

78 

8.1 

1/12.2 

None 

110'  70 

None 

2,200 

48 

None 

P5'  1)0 

None 

3,050 

50 

None 

1B8;  8S 

Slight 

3,600 
8*» 

61 
57 

70.6 

4,550 

7S 

8,2 

I  12.2 

Die.l 

• 


28 

.\llli<iiii;li  in  an;i--,-iri';i  tlii'  miinhor  of  cubic  ccmnnctcr^  nl  IjUhhI  ]>cr 
kilogram  iiiav  iinl  Ijc  incrca^cil  alici\c  iiiirmal.  llic  tulal  lilood  vnhiiiie 
iiiav  lie  larm'  in  rclaticm  tn  the  iinrnial  IkmIv  weight.  Case  25  luul  a 
liloiid  ma-s  <if  n\(.'r  S  liters.  With  tlic  disaiiiicaraiicc  of  his  cilcnia, 
he  l(i-t  14  kij;.  I  diisideriui,'  iiis  weiuhi  at  thi-.  time  in  rehttinii  to  the- 
hliiod  Ndhliiie.  S,()5l)  c.c,  Idlllid  (hiriiiL;  edema,  lie  had  lH''  c.c.  per 
IdliiiLjram,  which  is  an  extremely  hii,'h  value.  I'he  iialieiit  died  six 
weeks  later.  .\t  necrdjisv,  the  kidney  showed  numerous  small  scars 
throuuhom.  with  snme  atrii[)hy  (if  the  tuhtilar  lells.  an<l  also  an  actite 
intlainmaliirv  jinicess.  as  evidenced  1)\  inliltratiim  with  [lolymoriihii- 
nuclear  leukoc_\les.  There  wa--  a  slii;ht  chrdtiic  nephritis  with  an  acute 
terminal  process.  Myocarditis  was  exten>ive  am!  t'lhrnus  in  l\|'e,  with 
h\  p'crtropln-  nf  muscle  and  small  scattered  scars  everywhere.  The 
heart  wa-  df  tremendous  size.  It  is  (|uite  ])0ssible  that  in  this  instance 
the  Iari,'e  hldud  itiass  stood  in  caudal  relalidtiship  to  the  large  heart. 

1 1  y^oii-Hsioi!  aiui  i  lirciiii-  \  ,  ["In  ills. -  In  nineteen  determinations 
dti  thirtei'ii  cases  (  .\'d<.  M  to  4.i,  inclusi\e.  Tahle  8),  a  ]ilasma  volume 
greater  than  nortnal  wa-  foimd  onlv  diice.  while  tiic  total  blood  volume 
was  nut  fcitind  incri'.i-ed  in  nine  detcnnitiatiotis  uu  '-ix  cases.  Tills 
would  appear  to  demoii--trate  tliat  in  the-e  ca>e-  tile  hypertension  was 
nut  dependent  on  an  increase  in  hldiid  ni.i-^.  in  hyperten.-ioii,  the 
hlddil  \iilunie  is  normal  and  I  i"e>|iii  niK'  low.  Ilic  incrca>cd  tcn-ion 
wiiuli!  appic.ir.  tlien.'fdri\  tn  lie  tlepeiidciU  dn  a  \a-cular  s\.~teni  that  is 
tdu  -mall,  r.itlur  th.in  dii  ;i  lilood  \olnmc  th.it  i-  too  liruc.  The 
a\eraL;e  value  for  jiki-ma  w,i-  42,8  c.c.  per  kilogr.im.  and  fdr  the  \vhiile 
hlood,  7r  c,c,  per  kilogra.m,  in  both  in-tance--  the  lower  limit  of  iidrmal. 
The  sm.dl  \,\lue-  ,ire  not  dependent  on  edenin.  as  will  be  ascertained 
fvdiii  the  table,  -ince  in  onlv  three  ca-e-  was  even  ^liijlil  eilein.i  |'re-ent, 
ami  in  onl\-  one  w.i-  there  u:reat  cardiac  enl.irgcment.  The  rc-iilts  are 
in  -triking  coiitra>t  with  i!io-e  of  I'lesch.'* 

Scxer.d  df  the-e  ca-c-  arc  of  peculiar  intcc-l.  r.itieiil  .^'>.  who, 
on  one  deterniination  -hdwed,  .an  iiu  rca-cd  I'Li-ma  \olunu.  h,id  a 
marked  hematuria  -o  that  lunidrrhagc  iiiav  lia\e  accoimtcd  fdr  this 
linding.  .'^iiii-ei|ncnt  delermni.ilidii-.  ~hdwt'd  tlu'  pla>nia  \dluiiK>  td  be 
iidrm.al.  I'dlldwini;  \ene-e<  lidti  with  remocal  of  StXI  cc,  there  was  no 
decre.a-c  in  blood  iires-nic.  but  immediate  decrease  in  pla-ma  \(iliinie. 
\  Week  later,  there  wa-  an  inirea-e  in  ]ila-nia  to  abd\e  tli.it  fmind 
befdrc  the  \ene-eitidn.  but  wilbdiil  ,i  cdrre-l'diiding  increa-e  in  the 
bk  idd  \  dlnnic. 

i  hat  h\  pevtcn-idi,  can  e\i-t  in  ;i--dci,itidn  widi  ,a  IdW  bluod  \dluinc 
is  clearlv  indic.ated  b\  ^'.i-e  .U.  the  p.itient  -lidwiiig  i  -y-tdlic  blood 
pressure  of  1S<1  and  dia-tolic  of  pK),  Ihe  pla-iiia  w,a-  .U  c.c.  per  kilo- 
L;r,aiii   ami    the   total    bl 1.    .^1    c  i-,    per   kilo^i.nn.      The   hypertension 


29 


exi>tol  .Ic^piU'  the  tact  thai  the  i)atient's  total  WuiM  mass  was  not 
greater  than  the  jila-ina  vohinie  is  nurmally.  (Jbcsity  and  a  sHght 
edema  were  in  i>art  respiin>il)le  lor  these  low  values. 

Case  4;^  is  al-o  of  great  intere>t.  The  patient  is  the  only  one  of 
the  serie:,  presenting  marked  edema  at  the  lime  of  determination.  At 
this  time,  he  had  40  c.c.  of  plasma  per  kilogram.  Following  a  loss  of 
11  kg,  (  disippearance  of  edema),  the  [.lasma  volume  was  found  to 
be  slightly  lar^.  r,  4,().=l)  c.e..  eoinpared  with  .\S75  e.e.  It  is  evident 
that  tlie  Vilasma  volume  remained  ihe  same  throughout,  not  being 
influenced  by  the  presence  or  disappearanee  of  the  edema,  d'his  does 
not  always  occur,  a-  will  be  seen  by  contrasting  with  Ca-e  i.->. 

From'  thei^e  ci-e-,  it  would  appear  that  true  plethora  is  not  present 
in  hvpertenMon,  ;nid  that  a  small  or  contracted  vascular  system  and 
not  ini  incre.a-e  in  liln.)d  ma^:,  i-.  re.ponsiljle  lor  the  increased  blood 
pressure. 

Clir.'iiic  .W-l^lu-itis  iniliout  llyfnti'iisioii.  <  )nly  two  cases  (  Xos. 
44  and  4.=  ,  Table  Si  fall  into  lhi>  group.  I'atient  44  w.as  an  instance 
of  chronic  ii.arencbx  matous  nephritis,  wilh  slight  edema  and  very 
marked  .albumiiiuria.  The  i.|;i~nia  w.as  e-timated  twice,  three  week.- 
iiiter\eniiig.  iM.llowing  a  \ .'?  kg.  decrea-e  in  weight,  the  ]ilasma 
decrea-ed  ItMl  c.c.  I'.oth  ca-es  gave  v.alues  below  the  normal  average 
for  pla>iiia. 

Miscellaneous  Gii'itp.  .\  -mall  -erie^  of  miscellaneous  unrelated 
cases  (No-.  4«i  to  .=  ,\  inchi-ive,  T.able  S)  were  -tudied.  Case  H).  an 
instance  of  aneury-in  of  the  a-cemling  arch  of  the  aorta,  and  with  a 
moderate  tirade  of  aiieiina,  -hi.wed  identical  roults  on  two  occasions- 
an  aNera-e  normal  v.ilue  for  the  plasma,  ratieiits  4'>.  -uttering  wuh 
chronic  bnuuhiti-;  r\.  with  diroiiic  appendicitis;  4o.  a  neurasUiemc. 
.-md  4S.  with  cerebral   arteri(r-clero-i>,  all  showed   value-   within  the 

limit-  of  normal 

COM  Ml' NT 

Exiept  in  pregnancy.  hyi)eneii-ion  and  obe>ity.  the  number  of 
cases  sui.lic.i  in  any  one  con.iition  has  been  so  .mall  that  far-reaching 
conchi-ion-  .are  ini'iios-ible.  SutVicienl  evidence  has  been  adduced  to 
convince  us  n\  i ,;  i  an  increase  in  blood  volume  just  before  term  in 
uncomplicated  prc-nancy.  ( /' )  absence  of  a  causal  relation-hip  between 
increa-vd  bln...|  volume  .and  hvperlen-ion,  and  (  c )  of  a  relativel\ 
small  blo..,l  m.a--  in  obe-itv.  Inirther  blood  v<iltime  -Indies  in  tlie-e 
and  in  otiier  clinical  conditions  i-  contemplated. 

I'lom  ihi-  -uidv.  n  1-  api.arent  that  a  great  variation  in  the  blood 
niasr,  in  relation  to  body  weight  nia>  occur  in  any  one  disea-e.  Com- 
plication- of  anv  kind  mav  al-o  exert  a  great  inlUience  on   ihe  bl 1 

vohune.  ,1-  evidence,!  bv  Ca-e  -'  in  T.able  7.      It   become-  evident  llial 


30 


wo  cannet  lake  t'dr  j^ranU'd  llial  tlio  blood  Nnlumc  i>  iiKTcaM-'d  or 
dccrca^til  in  any  <,'iviMi  disca-c,  lull  inu-t  ainually  dticrmiiK'  il  in  each 
individual  i-a-u.  In  ihc  prc-cnt  --talc  (jI  i1k-  <iil)ie.:l.  ,<,'cncralizations 
arc  undesirable. 

SUMMARY 

I.  A  iiKtb.nil  f(,r  ibc  dctcniiinatioii  of  ]ila>ina  \nhinie  i^^  described. 
I'roni  tbe  plasma  volume  and  hematocrit  \alue-  the  blood  volume  can 
be  calculated. 

_'.  W  ilb  tlii>  mellind,  duplicate  determinatidiis  on  normal  subjects 
yield   identical   \alue>. 

,v  I  he  amount  nt  decrease  in  blood  \nlunie  a-  the  result  of  henior- 
rhai;e  and  "f  increase  following;  iiUravenou--  infu-inn  of  ,-alnie  has 
been  denn  in-traled. 

4.  Chanije-  in  blmul  \iilume  are  in-i,L;nilicant  in  experimentally 
induced  Inpcrlen.Mon  and  li\  pnten>ii  .n.  and  cannot  be  bron,i;ht  iiUO 
cau-.il  relalinn-hip  with  iheni. 

.-.  Tlie  ]'laMiia  nnvmallv  c(in>titules  apiimximately  ,^  per  cent,  or 
one-tuenlielh  nf  tbe  b<"ly  weight.  Ndrnial  iiidi\  idu.iV-  liave  ai)!)roxi- 
niatelv  rt>  k-.k:.  of  pla-ma  per  k^.,  the  extremes  beini;  irdui  4_'  to  .~0  c.c. 
per  kiliii;r.nri. 

(..  The  normal  heni.itdcrit  value-  (iblained  were  appr<j\iniately 
4.1  per  cent,   for  erylhrncyte?  and  r7  per  cent,   fur  plasma. 

7.  IJH.  bldd.l  )i(irmally  con-liiules  S,S  per  cent.,  or  1  11.4  of  the 
bodv  weii^ht.  Xnrnial  individual-  ba\e  api>roxiuiately  8.^  c.c.  <>i  blood 
per  kild^ram,  llie  extreme-  bcin^  7S  and  *'"  per  kileigram. 

8.  In   prei^nancv,  before  term,  the  1)1 1  and  plasma  \iihnne<  are 

increa-ed,  .\  iimditinu  nf  -eiou-  plethora  exi-t.-.  Within  a  week  or 
iwu  after  deli\ery.  the  bbni.!  value-  return  to  ncjrmal. 

'».    In  nbe-ii\-.  the  plasma  and  bb^od   \olumes  are  relatixely  .-mall. 
Ill,    Manv  ca.-e.-  of  anemia,  exhibit  a  relatively  lart;e  plasma  volume. 

II.  I',  ilvcythenna  in  the  sense  of  a  hi-h  blood  count  may  be 
dependent  nii  a  liiw  plasma  Mnnme.  Il  may  be  a-socialed  with  a  large 
plasma  \iilume.  in  which  ca-e  true  jilelhora  i-  indicated. 

IJ.    1  lyperi;]\cemia  exists  wilhcut  increase  in  blood  volume. 

l.v  In  anasarca  accompanying  in}oc,ardial  insuhiciency  the  blood 
\olnme  inav  be  absolutely  increaseil. 

14  .\  small  \ Illume  i-  -Imwu  in  many  eases  of  marked  hyperten- 
-ion.  Therefore  so  far  as  these  studies  go  it  would  apipear  that  hyper- 
ten-ion  is  not  dependent  on  a  large  blood  volume. 


I 


I 


I 


